Healthcare Provider Details

I. General information

NPI: 1528597689
Provider Name (Legal Business Name): NEAL DHANANJAY DHARMADHIKARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW STE 600
ATLANTA GA
30318-0920
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW STE 600
ATLANTA GA
30318-0920
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-9512
  • Fax: 404-351-9815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023012691
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2023012691
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101218
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: