Healthcare Provider Details

I. General information

NPI: 1619310984
Provider Name (Legal Business Name): SHWETA DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 ALPHARETTA HWY STE 710
ROSWELL GA
30076-4916
US

IV. Provider business mailing address

PO BOX 1914
COLUMBUS GA
31902-1914
US

V. Phone/Fax

Practice location:
  • Phone: 678-235-9168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number85393
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number85393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: