MEDICARE: DESAI & SHROFF MEDICAL

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1477105211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESAI & SHROFF MEDICAL

Provider Business Mailing Address
First Line	:	6025 PROFESSIONAL PKWY STE 200
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5610
Country	:	US
Telephone Number	:	770-949-0555
Fax Number	:	770-949-4424

Provider Business Practice Location Address
First Line	:	6025 PROFESSIONAL PKWY STE 200
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5610
Country	:	US
Telephone Number	:	770-949-0555
Fax Number	:	770-949-4424

Authorized Official
Title or Position	:	GEN PTR
Name	:	SAURABH DESAI
Credential	:	MD
Telephone Number	:	770-949-0555

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	07/11/2019

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