Healthcare Provider Details

I. General information

NPI: 1457914616
Provider Name (Legal Business Name): JANVI HEMANTKUMAR WADIWALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRIST CT
COLUMBUS GA
31909-3578
US

IV. Provider business mailing address

233 NORTH HOUSTON RD SUITE 140E
WARNER ROBINS GA
31093
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-2100
  • Fax: 478-975-6869
Mailing address:
  • Phone: 478-975-6880
  • Fax: 478-975-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number91251
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number91251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: