Healthcare Provider Details

I. General information

NPI: 1184299828
Provider Name (Legal Business Name): NISHA BHAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W PONCE DE LEON AVE STE 515
DECATUR GA
30030-2412
US

IV. Provider business mailing address

315 W PONCE DE LEON AVE STE 515
DECATUR GA
30030-2412
US

V. Phone/Fax

Practice location:
  • Phone: 470-744-1207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number105615
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: