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General NPI Number Information
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NPI Number | 1194146662
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Entity Type | Individual
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Provider Name | ALEXANDER MILAN DAVIDOVICH DPT
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Gender | Male
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Dates
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Enumeration Date | 12/30/2013
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 24 E CROSSVILLE RD SUITE 150
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City | ROSWELL
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State | GA
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Zip | 30075-7682
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Country | US
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Telephone | 415-577-0145
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Fax |
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Provider Business Mailing Address
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Address Line | 24 E CROSSVILLE RD SUITE 150
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City | ROSWELL
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State | GA
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Zip | 30075-7682
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Country | US
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Telephone | 415-577-0145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40558
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT012294
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License Number State | GA
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