Healthcare Provider Details

I. General information

NPI: 1144988684
Provider Name (Legal Business Name): MR. MIHIR CHANGELA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 S ATLANTA RD SE
ATLANTA GA
30339-1531
US

IV. Provider business mailing address

3171 FOREST GROVE TRL NW
ACWORTH GA
30101-6690
US

V. Phone/Fax

Practice location:
  • Phone: 404-792-6980
  • Fax:
Mailing address:
  • Phone: 678-995-2989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033393
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH033393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: