Healthcare Provider Details

I. General information

NPI: 1699009993
Provider Name (Legal Business Name): JIGISHU J DHABUWALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 DEPUTY BILL CANTRELL MEM
CUMMING GA
30040-3069
US

IV. Provider business mailing address

22101 MOROSS RD
DETROIT MI
48236-2148
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax: 678-513-8869
Mailing address:
  • Phone: 313-343-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number66591
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: