Healthcare Provider Details

I. General information

NPI: 1023100906
Provider Name (Legal Business Name): KAVITA MEHTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E GRAY ST
LOUISVILLE KY
40202
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2880
  • Fax:
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-434-8828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD471435
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35279
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: