Healthcare Provider Details

I. General information

NPI: 1467431940
Provider Name (Legal Business Name): NARAYAN S NAIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAKE HEARN DR NE SUITE300
ATLANTA GA
30319-1415
US

IV. Provider business mailing address

1200 LAKE HEARN DR NE SUITE300
BROOKHAVEN GA
30319-1415
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-1766
  • Fax: 404-851-1767
Mailing address:
  • Phone: 404-851-1766
  • Fax: 404-851-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number057223
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: