Healthcare Provider Details

I. General information

NPI: 1104350040
Provider Name (Legal Business Name): NIKHIL NEELKANTAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE AMC FAMILY MEDICINE RESIDENCY PROGRAM
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

303 PARKWAY DR NE AMC FAMILY MEDICINE RESIDENCY PROGRAM
ATLANTA GA
30312-1212
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-6464
  • Fax: 770-968-6461
Mailing address:
  • Phone: 770-968-6464
  • Fax: 770-968-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: