Healthcare Provider Details

I. General information

NPI: 1851749378
Provider Name (Legal Business Name): SUMIR MUKESH BRAHMBHATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 PROFESSIONAL PKWY STE 280
DOUGLASVILLE GA
30134-5627
US

IV. Provider business mailing address

6002 PROFESSIONAL PKWY STE 280
DOUGLASVILLE GA
30134-5627
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-2035
  • Fax: 770-999-2842
Mailing address:
  • Phone: 770-333-2035
  • Fax: 770-999-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number58787
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number93723
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: