Healthcare Provider Details

I. General information

NPI: 1396950234
Provider Name (Legal Business Name): AJAY K JOSHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

PO BOX 1316
INDIANAPOLIS IN
46206-1316
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-5400
  • Fax: 404-564-5403
Mailing address:
  • Phone: 877-440-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number62126
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number62126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: