Provider Demographics
NPI:1124040167
Name:SELVA, DENNIS A (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:SELVA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4855
Mailing Address - Country:US
Mailing Address - Phone:770-263-9101
Mailing Address - Fax:770-263-9102
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4855
Practice Address - Country:US
Practice Address - Phone:770-263-9101
Practice Address - Fax:770-263-9102
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-03-03
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Provider Licenses
StateLicense IDTaxonomies
GA64234208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000876521FMedicaid
GA000876521FMedicaid