Provider Demographics
NPI:1407947740
Name:BHAVIN H. JANI MD PC
Entity Type:Organization
Organization Name:BHAVIN H. JANI MD PC
Other - Org Name:BHAVIN H. JANI MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-207-1316
Mailing Address - Street 1:868 MICHAEL ETCHISON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8204
Mailing Address - Country:US
Mailing Address - Phone:770-207-1316
Mailing Address - Fax:770-217-6853
Practice Address - Street 1:868 MICHAEL ETCHISON RD
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8204
Practice Address - Country:US
Practice Address - Phone:770-207-1316
Practice Address - Fax:770-217-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044496261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00768996AMedicaid
GA11BDVLNMedicare ID - Type Unspecified
GA00768996AMedicaid