Provider Demographics
NPI:1013384205
Name:MEHTA, BHAVIK DHYANESH (AA)
Entity Type:Individual
Prefix:
First Name:BHAVIK
Middle Name:DHYANESH
Last Name:MEHTA
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 DEVON MILL WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5925
Mailing Address - Country:US
Mailing Address - Phone:404-660-7646
Mailing Address - Fax:
Practice Address - Street 1:1483 DEVON MILL WAY
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-5925
Practice Address - Country:US
Practice Address - Phone:404-660-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2096367H00000X
GA7751367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant