Provider Demographics
NPI:1780661066
Name:DAVID, ALICE KAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:KAVITHA
Last Name:DAVID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3696 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-736-1830
Mailing Address - Fax:706-821-2966
Practice Address - Street 1:1303 DANTIGNAC ST STE 1000
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-941-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG51793Medicaid
GA393770OtherBLUE CROSS BLUE SHIELD
GA000979569CMedicaid
GA7769368OtherAETNA
GA83BBBWSMedicare ID - Type Unspecified
GA393770OtherBLUE CROSS BLUE SHIELD
GA000979569CMedicaid