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General NPI Number Information
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NPI Number | 1336406131
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Entity Type | Organization
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Legal Business Name | NIRANJAN J DAVE MD PC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 3825 MEDICAL PARK DR SUITE 100
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City | AUSTELL
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State | GA
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Zip | 30106-6831
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Country | US
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Telephone | 770-944-2245
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Fax | 770-944-1337
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Provider Business Mailing Address
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Address Line | 3825 MEDICAL PARK DR SUITE 100
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City | AUSTELL
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State | GA
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Zip | 30106-6831
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Country | US
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Telephone | 770-944-2245
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Fax | 770-944-1337
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Authorized Official
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Title or Position | OWNER
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Name | NIRANJAN J DAVE
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Credential | MD
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Telephone | 770-944-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 031232
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License Number State | GA
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