Provider Demographics
NPI:1568473551
Name:KOTHARI, AJAY MAHESHCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:MAHESHCHANDRA
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:109 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-5508
Mailing Address - Country:US
Mailing Address - Phone:229-942-9534
Mailing Address - Fax:229-380-0267
Practice Address - Street 1:136 S LEE ST STE A
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3698
Practice Address - Country:US
Practice Address - Phone:229-780-0780
Practice Address - Fax:229-780-0781
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA269842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000757963CMedicaid
GA000757963CMedicaid
GA13BDFDHMedicare Oscar/Certification