| David Kavtaradze MD Inc | |
|
902 N 7th St # 100 Cordele GA 31015-3234 | |
| (229) 276-2286 | |
| Not Available |
| Full Name | David Kavtaradze MD Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 902 N 7th St # 100, Cordele, Georgia |
| Authorized Official Name and Position | David Kavtaradze (OWNER) |
| Authorized Official Contact | 2292714608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David Kavtaradze MD Inc 1008 N 7th St Cordele GA 31015-3761 Ph: (229) 271-4608 | David Kavtaradze MD Inc 902 N 7th St # 100 Cordele GA 31015-3234 Ph: (229) 276-2286 |
| NPI Number | 1386959179 |
|---|---|
| Provider Enumeration Date | 08/17/2010 |
| Last Update Date | 03/19/2021 |
| Certification Date | 03/19/2021 |
| Medicare PECOS PAC ID | 3173657673 |
|---|---|
| Medicare Enrollment ID | O20100819000728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386959179 | NPI | - | NPPES |
| 000976214D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 051148 (Georgia) | Primary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | 051148 (Georgia) | Secondary |
| Provider Name | David Kavtaradze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376516484 PECOS PAC ID: 7911052360 Enrollment ID: I20090908000537 |
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