Individual provider · NPI-1

Dr. Bavana Ketha, M.D.

Surgery · Lithonia, GA

NPI number1164818969

StatusActive

Last updated in NPPESMay 22, 2023

Details

NPI: 1164818969
Entity type: Individual (NPI-1)
Name: Dr. Bavana Ketha
Credential: M.D.
Sex: Female
Sole proprietor: Yes
Enumeration date: Apr 9, 2015
Certification date: May 22, 2023
Last updated: May 22, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208600000X	Surgery	0101275402	VA	Yes
390200000X	Student in an Organized Health Care Education/Training Program	–	–

Practice location

5910 Hillandale Dr Ste 203
Lithonia, GA 30058-1878

Phone 404-778-3712

Mailing address

5910 Hillandale Dr Ste 203
Lithonia, GA 30058-1878

Phone 404-778-3712

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