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General NPI Number Information
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NPI Number | 1538559190
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Entity Type | Individual
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Provider Name | MIRA DESAI AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1825 ROCKBRIDGE RD STE 15B
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3306
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Country | US
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Telephone | 470-444-3134
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Fax | 470-276-4370
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-352-1515
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Fax | 312-929-0373
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN309281
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN03074
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 13875
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0001299163
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 277.002161
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License Number State | IL
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