Provider Demographics
NPI:1073840864
Name:DHAR, JYOTSNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTSNA
Middle Name:K
Last Name:DHAR
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 1:1331 MARIETTA COUNTRY CLUB DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4733
Mailing Address - Country:US
Mailing Address - Phone:404-432-5404
Mailing Address - Fax:706-387-0073
Practice Address - Street 1:1331 MARIETTA COUNTRY CLUB DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4733
Practice Address - Country:US
Practice Address - Phone:404-432-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039087207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB91552Medicare UPIN
GAB915520281Medicare PIN