Healthcare Provider Details

I. General information

NPI: 1801535463
Provider Name (Legal Business Name): MAYA DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE FL 3
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE FL 3
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4351050239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: