Provider Demographics
NPI:1336108620
Name:DESAI, RAJIV DINKAR (MD OBGYN)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:DINKAR
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD OBGYN
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Mailing Address - Street 1:1500 OGLETHORPE AVENUE
Mailing Address - Street 2:BUILDING 500 SUITE D
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2184
Mailing Address - Country:US
Mailing Address - Phone:706-369-9375
Mailing Address - Fax:706-369-9382
Practice Address - Street 1:1500 OGLETHORPE AVENUE
Practice Address - Street 2:BUILDING 500 SUITE D
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2184
Practice Address - Country:US
Practice Address - Phone:706-369-9375
Practice Address - Fax:706-369-9382
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA029626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00392224BMedicaid
GA000392224BMedicaid
GA000392224BMedicaid