MEDICARE: FIDEL DESIR MD, PHD

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	261QP0904X	Federal Public Health Clinic/Center

General Provider Information

NPI Number	:	1508105545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIDEL DESIR MD, PHD

Provider Business Mailing Address
First Line	:	1600 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4018
Country	:	US
Telephone Number	:	404-498-0000
Fax Number	:

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

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	06/22/2023

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