Healthcare Provider Details

I. General information

NPI: 1396031308
Provider Name (Legal Business Name): NEIL KISHOR DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW SUITE 635
ATLANTA GA
30309-1613
US

IV. Provider business mailing address

2420 DOUBLE CHURCHES RD
COLUMBUS GA
31909-2983
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax: 404-367-3558
Mailing address:
  • Phone: 706-324-7882
  • Fax: 706-324-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number072540
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number72540
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: