Provider Demographics
NPI:1184836488
Name:NARIANI, SANJAY A (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:A
Last Name:NARIANI
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 1:3457 LAWRENCEVILLE SUWANEE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6426
Mailing Address - Country:US
Mailing Address - Phone:678-714-8522
Mailing Address - Fax:678-714-8542
Practice Address - Street 1:3457 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6426
Practice Address - Country:US
Practice Address - Phone:678-714-8522
Practice Address - Fax:678-714-8542
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00083235Medicaid
GA582642339OtherFEDERAL TAX ID
GA11BDWLNMedicare ID - Type Unspecified
GAH10875Medicare UPIN