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General NPI Number Information
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NPI Number | 1831150598
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Entity Type | Individual
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Provider Name | KAMLESH DHIRUBHAI NAYAK MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 4904 TIMBER RIDGE DR SUITE 102
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1826
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Country | US
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Telephone | 770-489-8165
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Fax | 770-489-7884
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Provider Business Mailing Address
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Address Line | 4904 TIMBER RIDGE DR SUITE 102
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1826
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Country | US
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Telephone | 770-489-8165
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Fax | 770-489-7884
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 032003
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License Number State | GA
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