Basic Information
| Provider Information | |||||||||
| NPI: | 1285651083 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ALAVI | ||||||||
| FirstName: | HOSSAIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2258 WRIGHTSBORO RD | ||||||||
| Address2: | STE 302 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309044887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064817070 | ||||||||
| FaxNumber: | 7064817079 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 FREEDOM WAY | ||||||||
| Address2: | CHARLIE NORWOOD VA MEDICAL CENTER | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309046258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067330188 | ||||||||
| FaxNumber: | 7068233911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 042513 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 000744972C | 05 | GA | MEDICAID | G42513 | 05 | SC | MEDICAID |