Healthcare Provider Details

I. General information

NPI: 1477484939
Provider Name (Legal Business Name): DAVIT KALMAKHELIDZE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E HWY 90
SIERRA VISTA AZ
85635
US

IV. Provider business mailing address

5700 E HWY 90
SIERRA VISTA AZ
85635
US

V. Phone/Fax

Practice location:
  • Phone: 520-263-3190
  • Fax: 520-844-4953
Mailing address:
  • Phone: 520-263-3190
  • Fax: 520-844-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR82325
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: