Provider Demographics
NPI:1609859735
Name:DAVE, AMITA N (MD)
Entity type:Individual
Prefix:MRS
First Name:AMITA
Middle Name:N
Last Name:DAVE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3825 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6831
Mailing Address - Country:US
Mailing Address - Phone:770-941-8100
Mailing Address - Fax:678-945-9331
Practice Address - Street 1:3825 MEDICAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6831
Practice Address - Country:US
Practice Address - Phone:770-941-8100
Practice Address - Fax:678-945-9331
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2015-11-13
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Provider Licenses
StateLicense IDTaxonomies
GA023724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA062147OtherBLUE CROSS
003116112AOtherMEDICAID PAYEE ID
GA000405402DMedicaid
110124115OtherRAILROAD MEDICARE
GA062147OtherBLUE CROSS
GA000405402DMedicaid
003116112AOtherMEDICAID PAYEE ID