Healthcare Provider Details

I. General information

NPI: 1518661156
Provider Name (Legal Business Name): ALEKSANDRA RADIVOJEVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

V. Phone/Fax

Practice location:
  • Phone: 470-732-5493
  • Fax: 470-986-7056
Mailing address:
  • Phone: 470-732-5493
  • Fax: 470-986-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number111148
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: