Provider Demographics
NPI:1073745162
Name:GANDHI, KAUSHANG A (MD)
Entity Type:Individual
Prefix:
First Name:KAUSHANG
Middle Name:A
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 213
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6442
Practice Address - Country:US
Practice Address - Phone:470-956-9480
Practice Address - Fax:678-842-5539
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070677A207RC0000X
GA79651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01678721OtherMEDICARE RAILROAD PTAN
IN201112750Medicaid
IN267030032Medicare PIN
IN266180557Medicare PIN