Provider Demographics
NPI:1558310334
Name:DASOVEANU, GEORGE ELVIS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELVIS
Last Name:DASOVEANU
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:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1170
Mailing Address - Country:US
Mailing Address - Phone:470-325-0159
Mailing Address - Fax:470-325-0191
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-475-5076
Practice Address - Fax:706-475-6676
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45764208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG87514Medicare UPIN