Provider Demographics
NPI:1609091883
Name:RAJ K GANDHI & CHANDI P SHARMA PTR
Entity Type:Organization
Organization Name:RAJ K GANDHI & CHANDI P SHARMA PTR
Other - Org Name:HIGHTOWER MEDICAL & DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-794-0014
Mailing Address - Street 1:2645 DONALD LEE HOLLOWELL PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-8351
Mailing Address - Country:US
Mailing Address - Phone:404-794-0014
Mailing Address - Fax:
Practice Address - Street 1:2645 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-8351
Practice Address - Country:US
Practice Address - Phone:404-794-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2008-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA917736207R00000X
GA015563207V00000X
GA019638207W00000X
GA016914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000151522AMedicaid
GA000014539CMedicaid
GA000009765BMedicaid
GA085000870GMedicaid
GA000143954AMedicaid
GA000143954AMedicaid
GA000014539CMedicaid
GAD39919Medicare UPIN
GAD28901Medicare UPIN
GAD30793Medicare UPIN
GA128526705BMedicare ID - Type UnspecifiedSHARMA
GA085000870GMedicaid