Healthcare Provider Details

I. General information

NPI: 1558006684
Provider Name (Legal Business Name): JIGAR SARAIYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 HIGHWAY 20 SE STE H
CONYERS GA
30013-2087
US

IV. Provider business mailing address

6225 LOCHMOOR CT
SOLON OH
44139-5942
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-3565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123218
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13400
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: