MEDICARE: STONE MOUNTAIN FAMILY MEDICINE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194283689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONE MOUNTAIN FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	1183 S HAIRSTON RD STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2796
Country	:	US
Telephone Number	:	404-296-8858
Fax Number	:	404-296-5599

Provider Business Practice Location Address
First Line	:	1183 S HAIRSTON RD STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2796
Country	:	US
Telephone Number	:	404-296-8858
Fax Number	:	404-296-5599

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	RHOIT M DESAI
Credential	:	MD
Telephone Number	:	404-296-8858

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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