MEDICARE: DR. NIDHI JAIN MD, MPH

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	055832	GA

General Provider Information

NPI Number	:	1982649422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIDHI JAIN MD, MPH

Provider Business Mailing Address
First Line	:	1376 BROOKHAVEN VILLAGE CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4095
Country	:	US
Telephone Number	:	404-848-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1376 BROOKHAVEN VILLAGE CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4095
Country	:	US
Telephone Number	:	404-848-0261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/08/2007

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