Provider Demographics
NPI:1184837841
Name:MINERVE, HAROLD ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ADRIAN
Last Name:MINERVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 PRESTON OAKS PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3986
Mailing Address - Country:US
Mailing Address - Phone:770-696-2071
Mailing Address - Fax:
Practice Address - Street 1:4536 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:STE 250
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6200
Practice Address - Country:US
Practice Address - Phone:770-455-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44544208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000816582CMedicaid
GA34BDDQFMedicare PIN