Provider Demographics
NPI:1982740726
Name:KOVACIC, ANDREA HARNER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:HARNER
Last Name:KOVACIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:21 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2009
Practice Address - Country:US
Practice Address - Phone:770-773-9201
Practice Address - Fax:770-773-9219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055805834AMedicaid
GAI43314Medicare UPIN
GA08CBBBCMedicare ID - Type Unspecified