Healthcare Provider Details

I. General information

NPI: 1295721124
Provider Name (Legal Business Name): MEENA J. KAVIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HURRICANE SHOALS RD NW STE 100
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

497 WINN WAY SUITE A-210
DECATUR GA
30030-1712
US

V. Phone/Fax

Practice location:
  • Phone: 404-645-7150
  • Fax:
Mailing address:
  • Phone: 404-294-7033
  • Fax: 404-296-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number042624
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: