Healthcare Provider Details

I. General information

NPI: 1790050037
Provider Name (Legal Business Name): AMIT PRABHAKAR M.D., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

DEPARTMENT OF ANESTHESIOLOGY, 2ND FLOOR 550 PEACHTREE STREET, NE
ATLANTA GA
30308
US

V. Phone/Fax

Practice location:
  • Phone: 985-788-6876
  • Fax:
Mailing address:
  • Phone: 985-788-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number78694
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number78694
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD.206360
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: