Provider Demographics
NPI:1225213804
Name:MEHTA, TEJAS R (MD)
Entity Type:Individual
Prefix:
First Name:TEJAS
Middle Name:R
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5445 MERIDIAN MARKS RD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4763
Mailing Address - Country:US
Mailing Address - Phone:404-843-6320
Mailing Address - Fax:404-843-6321
Practice Address - Street 1:5445 MERIDIAN MARKS RD
Practice Address - Street 2:SUITE 490
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4763
Practice Address - Country:US
Practice Address - Phone:404-843-6320
Practice Address - Fax:404-843-6321
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0575472080P0206X
FLME1045512080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH518XMedicare PIN
FLCH518YMedicare PIN
GA202I103124Medicare PIN
GA202I373125Medicare PIN
FLCH518ZMedicare PIN