Healthcare Provider Details

I. General information

NPI: 1093790677
Provider Name (Legal Business Name): ASHIS H TAYAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-2326
  • Fax: 770-422-7797
Mailing address:
  • Phone: 770-422-2326
  • Fax: 770-422-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD061548L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number89856
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: