Healthcare Provider Details

I. General information

NPI: 1053701268
Provider Name (Legal Business Name): VIVEK SAROHA MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

105 KIRK CROSSING DR
DECATUR GA
30030-3773
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 361-694-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75887
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number75887
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: