Healthcare Provider Details

I. General information

NPI: 1346826211
Provider Name (Legal Business Name): KETKI DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0006
US

IV. Provider business mailing address

3875 MANHASSETT PL NE
MARIETTA GA
30066-3090
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7000
  • Fax:
Mailing address:
  • Phone: 404-917-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number104936
License Number StateGA
# 2
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: