Healthcare Provider Details

I. General information

NPI: 1386643229
Provider Name (Legal Business Name): KISHOR DAHYABHAI DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 DOUBLE CHURCHES RD
COLUMBUS GA
31909-2741
US

IV. Provider business mailing address

2420 DOUBLE CHURCHES RD
COLUMBUS GA
31909-2741
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-7882
  • Fax: 706-324-7886
Mailing address:
  • Phone: 706-324-7882
  • Fax: 706-324-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number026707
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: