Provider Demographics
NPI:1871659656
Name:DEVICA ALAPPAN MDPC
Entity type:Organization
Organization Name:DEVICA ALAPPAN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVICA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-323-3400
Mailing Address - Street 1:1900 11TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:706-323-3400
Mailing Address - Fax:706-321-1684
Practice Address - Street 1:1900 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-323-3400
Practice Address - Fax:706-321-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00898796AMedicaid
GA00898796AMedicaid