Healthcare Provider Details

I. General information

NPI: 1568443273
Provider Name (Legal Business Name): DINESH R GANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 FORSYTH ST SW
ATLANTA GA
30303-3786
US

IV. Provider business mailing address

50 MARQUIS RD
FREEPORT ME
04032-6477
US

V. Phone/Fax

Practice location:
  • Phone: 404-521-2410
  • Fax: 877-411-0199
Mailing address:
  • Phone: 207-865-6131
  • Fax: 207-865-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00007119
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberEL191035
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74119
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: