Provider Demographics
NPI:1578794921
Name:DAVOODI, EMILY HAMMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:HAMMOND
Last Name:DAVOODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1488 JESSE JEWELL PKWY SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3804
Mailing Address - Country:US
Mailing Address - Phone:770-532-7179
Mailing Address - Fax:
Practice Address - Street 1:1488 JESSE JEWELL PKWY SE STE 100
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3804
Practice Address - Country:US
Practice Address - Phone:770-532-7179
Practice Address - Fax:770-534-1312
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009100000Medicaid
FLHJ359ZMedicare PIN