Healthcare Provider Details

I. General information

NPI: 1558310334
Provider Name (Legal Business Name): GEORGE ELVIS DASOVEANU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606
US

IV. Provider business mailing address

PO BOX 1170
LAWRENCEVILLE GA
30046-1170
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5076
  • Fax: 706-475-6676
Mailing address:
  • Phone: 470-325-0159
  • Fax: 470-325-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number45764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: