Provider Demographics
NPI:1407220742
Name:DAVARI, AHMAD (DC)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:DAVARI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 KINGSTON CT.
Mailing Address - Street 2:SUITE-C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:678-401-8275
Mailing Address - Fax:678-401-8275
Practice Address - Street 1:2130 KINGSTON CT.
Practice Address - Street 2:SUITE-C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:678-401-8275
Practice Address - Fax:678-401-8275
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU48099Medicare UPIN