Healthcare Provider Details

I. General information

NPI: 1659206571
Provider Name (Legal Business Name): RAVILA BHIMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

5975 MEMORIAL DR
STONE MOUNTAIN GA
30083-3429
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-9497
  • Fax:
Mailing address:
  • Phone: 786-525-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5464
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: