Healthcare Provider Details

I. General information

NPI: 1508211376
Provider Name (Legal Business Name): RAVI DINESH BHATIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL RD STE B
CANTON GA
30114-2409
US

IV. Provider business mailing address

1155 MONTE DR
MARIETTA GA
30062-2896
US

V. Phone/Fax

Practice location:
  • Phone: 404-761-0819
  • Fax: 770-528-6019
Mailing address:
  • Phone: 404-808-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number89387
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: