Provider Demographics
NPI:1487297164
Name:DEAVMED L.L.C
Entity type:Organization
Organization Name:DEAVMED L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-925-5884
Mailing Address - Street 1:1481 BOURDON BELL DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7459
Mailing Address - Country:US
Mailing Address - Phone:770-925-5884
Mailing Address - Fax:
Practice Address - Street 1:3915 CASCADE RD SW STE T-90
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8660
Practice Address - Country:US
Practice Address - Phone:770-925-5884
Practice Address - Fax:888-440-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty