Healthcare Provider Details

I. General information

NPI: 1225088198
Provider Name (Legal Business Name): JIGNESH N GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEACHTREE ST NE SUITE 400
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

1800 PEACHTREE ST NW STE 750
ATLANTA GA
30309-2530
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-7654
  • Fax: 404-609-7605
Mailing address:
  • Phone: 404-351-7654
  • Fax: 404-609-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number047433
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: