Individual
YELIZAVETA VALERIYEVNA MAKHATADZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7301 ROGERS AVE, FORT SMITH, AR 72903-4100
(479) 314-5175
(479) 314-5185
Mailing address
7301 ROGERS AVE, FORT SMITH, AR 72903-4100
(479) 314-5175
(479) 314-5185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E4609
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159847001
—
AR
05
—
200116350A
—
OK
Enumeration date
05/08/2006
Last updated
08/02/2013
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