MEDICARE: KOOSH N DESAI MD PC

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	:	1700753035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOOSH N DESAI MD PC

Provider Business Mailing Address
First Line	:	2410 DOUBLE CHURCHES RD STE A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2987
Country	:	US
Telephone Number	:	706-576-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 DOUBLE CHURCHES RD STE A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2987
Country	:	US
Telephone Number	:	706-576-4600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KOOSH N DESAI
Credential	:	MD
Telephone Number	:	706-576-4600

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	10/21/2025

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