Provider Demographics
NPI:1386732048
Name:DAUS, KEVIN M (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:DAUS
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2675 N DECATUR RD STE 501
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6134
Mailing Address - Country:US
Mailing Address - Phone:404-296-1424
Mailing Address - Fax:404-501-7393
Practice Address - Street 1:2675 NORTH DECATUR RD
Practice Address - Street 2:STE 404
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-296-1424
Practice Address - Fax:404-501-7393
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012125207V00000X
KY26626207V00000X
GA028394207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD00406095AMedicaid
118352OtherBCBS
1386732048OtherNPI
118352OtherBCBS