=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154140267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENEVA FAMILY MEDICINE AND AESTHETICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3275 N POINT PKWY STE 204
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-4708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-495-1928
-----------------------------------------------------
Fax | 470-851-3466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3275 N POINT PKWY STE 204
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-4708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-704-9687
-----------------------------------------------------
Fax | 866-531-9631
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | SHIVANI JERATH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-704-9687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------