Healthcare Provider Details

I. General information

NPI: 1033452354
Provider Name (Legal Business Name): PRATIK SANDESARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1364 CLIFTON RD NE STE F622
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-5658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number76580
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number76580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: