Healthcare Provider Details

I. General information

NPI: 1750816716
Provider Name (Legal Business Name): MEERA BRAHMBHATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 COGBURN AVENUE SUITE 100
MARIETTA GA
30060-1008
US

IV. Provider business mailing address

835 COGBURN AVNUE SUITE 250
MARIETTA GA
30060-1010
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-5557
  • Fax: 770-422-5456
Mailing address:
  • Phone: 770-442-8815
  • Fax: 770-422-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number93556
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number93556
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number93556
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number93556
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: