Provider Demographics
NPI:1285651083
Name:ALAVI, HOSSAIN (MD)
Entity Type:Individual
Prefix:
First Name:HOSSAIN
Middle Name:
Last Name:ALAVI
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 1:2258 WRIGHTSBORO RD
Mailing Address - Street 2:STE 302
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4887
Mailing Address - Country:US
Mailing Address - Phone:706-481-7070
Mailing Address - Fax:706-481-7079
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:CHARLIE NORWOOD VA MEDICAL CENTER
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-823-3911
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042513207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000744972CMedicaid
SCG42513Medicaid
SCG42513Medicaid
GA06BDHNJMedicare ID - Type Unspecified
00141336Medicare ID - Type UnspecifiedRAILROAD