Provider Demographics
NPI:1205195617
Name:VEKARIA, ANJALI S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJALI
Middle Name:S
Last Name:VEKARIA
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 1:73 PRESTIGE LN STE 101
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6370
Mailing Address - Country:US
Mailing Address - Phone:770-800-3455
Mailing Address - Fax:
Practice Address - Street 1:1521 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-3413
Practice Address - Country:US
Practice Address - Phone:770-800-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA89038207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003261420BMedicaid