MEDICARE: DAVIT MRELASHVILI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	54534	CT
2	2084N0400X	Neurology Physician	30863	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA30189482	OTHER	SC	MEDICARE-- PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760539555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVIT MRELASHVILI MD

Provider Business Mailing Address
First Line	:	PO BOX 743904
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3904
Country	:	US
Telephone Number	:	803-296-7320
Fax Number	:	803-296-7330

Provider Business Practice Location Address
First Line	:	8 RICHLAND MEDICAL PARK DR STE 420
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-8004
Country	:	US
Telephone Number	:	803-545-6050
Fax Number	:	803-545-6051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	01/19/2026

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Directions to “ DAVIT MRELASHVILI MD” Practice Location

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