Healthcare Provider Details

I. General information

NPI: 1063355055
Provider Name (Legal Business Name): NAMRA VINAYBHAI GOHIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 UPPER RIVERDALE ROAD SOUTHERN REGIONAL MEDICAL CENTE
RIVERDALE GA
30274
US

IV. Provider business mailing address

11 UPPER RIVERDALE ROAD, SW SOUTHERN REGIONAL MEDICAL C
RIVERDALE GA
30274
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-8570
  • Fax:
Mailing address:
  • Phone: 770-991-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: