Healthcare Provider Details

I. General information

NPI: 1760539555
Provider Name (Legal Business Name): DAVIT MRELASHVILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PARKERSON LN
APEX NC
27502-4176
US

IV. Provider business mailing address

109 PARKERSON LN
APEX NC
27502-4176
US

V. Phone/Fax

Practice location:
  • Phone: 404-429-7222
  • Fax:
Mailing address:
  • Phone: 404-429-7222
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number54534
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberS1665
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30863
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: