Healthcare Provider Details

I. General information

NPI: 1093344517
Provider Name (Legal Business Name): TEJ DESAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 FRIENDSHIP RD STE 100
BRASELTON GA
30517-5638
US

IV. Provider business mailing address

1930 BRANNAN RD
MCDONOUGH GA
30253-4310
US

V. Phone/Fax

Practice location:
  • Phone: 678-205-8387
  • Fax: 678-808-1039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number112480
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberOS024693
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: