MEDICARE: MR. ANIL J DESAI MD

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	207RH0003X	Hematology & Oncology Physician	035033	GA
2	207R00000X	Internal Medicine Physician	035033	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	:	1578670071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANIL J DESAI MD

Provider Business Mailing Address
First Line	:	3641 HIGHWAY 20 SE
Second Line	:	SUITE A
City	:	CONYERS
State	:	GA
Zip	:	30013-3064
Country	:	US
Telephone Number	:	770-918-1234
Fax Number	:	770-918-1235

Provider Business Practice Location Address
First Line	:	4139 BAKER ST NE
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-1405
Country	:	US
Telephone Number	:	770-786-9499
Fax Number	:	770-786-9757

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	02/25/2016

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