Healthcare Provider Details

I. General information

NPI: 1952900326
Provider Name (Legal Business Name): MAHANTKESHAVJIVANDAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2020
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 CICERO DR STE 140
ALPHARETTA GA
30022-1179
US

IV. Provider business mailing address

11175 CICERO DR STE 140
ALPHARETTA GA
30022-1179
US

V. Phone/Fax

Practice location:
  • Phone: 404-835-1575
  • Fax: 404-835-1535
Mailing address:
  • Phone: 404-835-1575
  • Fax: 404-835-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KINJAL GHELANI
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 404-835-1575