Organization
AMITA N DAVE, MD PC
Active
Organization
AMITA N DAVE, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMITA N DAVE MD (OWNER)
(770) 948-8680
Entity
Organization
Contact information
Practice address
3825 MEDICAL PARK DR, SUITE 100, AUSTELL, GA 30106-6831
(770) 948-8680
(770) 944-1337
Mailing address
3825 MEDICAL PARK DR, SUITE 100, AUSTELL, GA 30106-6831
(770) 948-8680
(770) 944-1337
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 NUMBER
—
Enumeration date
04/18/2012
Last updated
04/18/2012
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