Healthcare Provider Details

I. General information

NPI: 1003266073
Provider Name (Legal Business Name): MESHVA AKWALIA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

IV. Provider business mailing address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-2778
  • Fax:
Mailing address:
  • Phone: 229-257-3166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number98715
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18086
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1810
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: