Individual
MRS. AMITA N DAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3825 MEDICAL PARK DR, SUITE 201, AUSTELL, GA 30106-6831
(770) 941-8100
(678) 945-9331
Mailing address
3825 MEDICAL PARK DR, SUITE 201, AUSTELL, GA 30106-6831
(770) 941-8100
(678) 945-9331
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
023724
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000405402D
—
GA
01
—
003116112A
MEDICAID PAYEE ID
—
01
—
062147
BLUE CROSS
GA
01
—
110124115
RAILROAD MEDICARE
—
Enumeration date
11/22/2005
Last updated
11/13/2015
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