Provider Demographics
NPI:1316903255
Name:KAVALI, CARMEN M (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:KAVALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:MICHELLE
Other - Last Name:KAVALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6045 BARFIELD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-250-3333
Mailing Address - Fax:404-250-0175
Practice Address - Street 1:6045 BARFIELD RD
Practice Address - Street 2:STE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-250-3333
Practice Address - Fax:404-250-0175
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0509682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58433Medicare UPIN