Provider Demographics
NPI:1194146662
Name:DAVIDOVICH, ALEXANDER MILAN (DPT)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:MILAN
Last Name:DAVIDOVICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E CROSSVILLE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7682
Mailing Address - Country:US
Mailing Address - Phone:415-577-0145
Mailing Address - Fax:
Practice Address - Street 1:24 E CROSSVILLE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7682
Practice Address - Country:US
Practice Address - Phone:415-577-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405582251X0800X
GAPT0122942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic