Provider Demographics
NPI:1871538801
Name:DAVE, MOHAK P (MD)
Entity type:Individual
Prefix:
First Name:MOHAK
Middle Name:P
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2938
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-2938
Mailing Address - Country:US
Mailing Address - Phone:770-536-2146
Mailing Address - Fax:770-536-7895
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-536-2146
Practice Address - Fax:770-536-7895
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA051128207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000958669POtherMEDICAID URGENT CARE FRIENDSHIP
GA000958669NMedicaid
GA93BFDXQOtherMEDICARE PIN URGENT CARE FRIENDSHIP
GAH49080Medicare UPIN
GA000958669NMedicaid