Provider Demographics
NPI:1295815645
Name:DAVE, YAGNESH (MD)
Entity Type:Individual
Prefix:DR
First Name:YAGNESH
Middle Name:
Last Name:DAVE
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 1:1700 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2195
Mailing Address - Country:US
Mailing Address - Phone:770-736-2445
Mailing Address - Fax:770-736-2322
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:770-736-2445
Practice Address - Fax:770-736-2322
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101498207R00000X, 208M00000X
GA76499208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00617112OtherMEDICARE RAILROAD
IL036101498Medicaid
IL036101498Medicaid
ILK48323Medicare PIN
ILK48321Medicare PIN