Healthcare Provider Details

I. General information

NPI: 1326218686
Provider Name (Legal Business Name): SHAILESH GANDHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 LAKEFIELD CT SE STE A
CONYERS GA
30013-1776
US

IV. Provider business mailing address

6555 SUGARLOAF PKWY # 258-307
DULUTH GA
30097-4930
US

V. Phone/Fax

Practice location:
  • Phone: 770-277-7195
  • Fax: 888-747-9242
Mailing address:
  • Phone: 770-277-7195
  • Fax: 888-747-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC53284
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC53284
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number034139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: