Healthcare Provider Details

I. General information

NPI: 1609091883
Provider Name (Legal Business Name): RAJ K GANDHI & CHANDI P SHARMA PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 DONALD LEE HOLLOWELL PKWY NW
ATLANTA GA
30318-8351
US

IV. Provider business mailing address

2645 DONALD LEE HOLLOWELL PKWY NW
ATLANTA GA
30318-8351
US

V. Phone/Fax

Practice location:
  • Phone: 404-794-0014
  • Fax:
Mailing address:
  • Phone: 404-794-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number917736
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number015563
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number019638
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number016914
License Number StateGA

VIII. Authorized Official

Name: MEERA MEHTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 404-794-0014