Healthcare Provider Details

I. General information

NPI: 1245636596
Provider Name (Legal Business Name): JITEN P KOTHADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 LIMESTONE OVERLOOK
GAINESVILLE GA
30501-7443
US

IV. Provider business mailing address

2324 LIMESTONE OVERLOOK
GAINESVILLE GA
30501-7443
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-8109
  • Fax:
Mailing address:
  • Phone: 770-536-8109
  • Fax: 770-536-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number59366
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59366
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number111423
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: