Provider Demographics
NPI:1083681589
Name:GOVIL, SANDEEP KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:KUMAR
Last Name:GOVIL
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 1:2018 IVY RIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3133
Mailing Address - Country:US
Mailing Address - Phone:404-783-9940
Mailing Address - Fax:
Practice Address - Street 1:3969 S COBB DR SE
Practice Address - Street 2:SUITE 202
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:404-783-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBSGJMedicare ID - Type Unspecified
GAH67212Medicare UPIN