MEDICARE: DR. SANJAY A. BHANSALI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	035006	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023010220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY A. BHANSALI M.D.

Provider Business Mailing Address
First Line	:	5881 GLENRIDGE DR NE
Second Line	:	STE 230
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-943-0170
Fax Number	:	404-943-0171

Provider Business Practice Location Address
First Line	:	5881 GLENRIDGE DR NE
Second Line	:	STE 230
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-943-0170
Fax Number	:	404-943-0171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/24/2012

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