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General NPI Number Information
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NPI Number | 1255770780
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Entity Type | Individual
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Provider Name | ASHIM MEHTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 306 SHORTER AVE NW
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City | ROME
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State | GA
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Zip | 30165-4268
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Country | US
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Telephone | 706-509-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 2ND AVE STE 103
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City | ROME
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State | GA
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Zip | 30161-3210
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Country | US
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Telephone | 706-509-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 077292
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 77292
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License Number State | GA
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