Provider Demographics
NPI:1164561817
Name:PARIKH, AMITA SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:SANJAY
Last Name:PARIKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 TELFAIR CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5151
Mailing Address - Country:US
Mailing Address - Phone:678-985-0400
Mailing Address - Fax:
Practice Address - Street 1:1695 DULUTH HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5072
Practice Address - Country:US
Practice Address - Phone:770-822-4410
Practice Address - Fax:770-822-4055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG22014Medicare UPIN
GA11BDVGZMedicare ID - Type Unspecified