Individual
DR. E. VICTOR PAVAMANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 MEDICAL WAY, SUITE 220, SNELLVILLE, GA 30078-2166
(770) 972-7999
(770) 972-9528
Mailing address
1600 MEDICAL WAY, SUITE 220, SNELLVILLE, GA 30078-2166
(770) 972-7999
(770) 972-9528
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
018411
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000135616A
—
GA
05
—
000135616B
—
GA
01
—
581411492
IRS INDIVIDUAL TAXPAYER #
—
01
—
P00393203
RR MEDICARE
GA
Enumeration date
03/22/2006
Last updated
11/07/2012
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