Provider Demographics
NPI:1063477222
Name:PREVOSTI, LOUIS G (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:G
Last Name:PREVOSTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-446-2800
Mailing Address - Fax:404-446-2809
Practice Address - Street 1:1100 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 165
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-446-2800
Practice Address - Fax:404-446-2809
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034923208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000469994FMedicaid
GA330005751OtherRR MEDICARE
GA610271OtherBCBS EDI
GA610271OtherBCBS EDI
GAE93181Medicare UPIN