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Individual

ALEXANDER T GEDEVANISHVILI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1602 VERNON RD STE 300, LAGRANGE, GA 30240
(706) 242-5100
(706) 812-2454
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
054099
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
192405896A
GA
Enumeration date
09/14/2005
Last updated
11/05/2019
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