Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 050968 | GA |
NPI | 1316903255 |
---|---|
Provider Name | Carmen M Kavali |
First Address | Atlanta, GA 30328 |
Second Address | Atlanta, GA 30328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H58433 | (02) |