Healthcare Provider Details

I. General information

NPI: 1972130839
Provider Name (Legal Business Name): NIKITA DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 PADDOCKS PKWY STE 100
SUWANEE GA
30024-9119
US

IV. Provider business mailing address

3390 PADDOCKS PKWY STE 100
SUWANEE GA
30024-9119
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-0828
  • Fax:
Mailing address:
  • Phone: 248-804-3084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number96801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: