Healthcare Provider Details

I. General information

NPI: 1982921409
Provider Name (Legal Business Name): PREYASI KOTHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

49 JESSE HILL DRIVE
ATLANTA GA
30303-4078
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax:
Mailing address:
  • Phone: 404-616-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number070166
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: