Healthcare Provider Details

I. General information

NPI: 1063612646
Provider Name (Legal Business Name): SWAPAN AKHILESH DHOLAKIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BOULEVARD NE SUITE 345
ATLANTA GA
30312-4205
US

IV. Provider business mailing address

4183 SCYLER WAY
TUCKER GA
30084-2185
US

V. Phone/Fax

Practice location:
  • Phone: 404-653-0039
  • Fax: 404-653-0159
Mailing address:
  • Phone: 573-823-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number067908
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: