Provider Demographics
NPI:1619915584
Name:PARIKH, ASHA N (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:N
Last Name:PARIKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 769609
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8224
Mailing Address - Country:US
Mailing Address - Phone:404-634-1556
Mailing Address - Fax:404-634-1557
Practice Address - Street 1:#3 CORPORATE SQUARE
Practice Address - Street 2:STE. 103
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2014
Practice Address - Country:US
Practice Address - Phone:404-634-1556
Practice Address - Fax:404-634-1557
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028850207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000334389GMedicaid
GA000334386DMedicaid
GA000334386AMedicaid
GA00033486CMedicaid
GA003129966AMedicaid
GA1609816123OtherGEORGIA CLINIC PC GROUP NPI#
GA00033486CMedicaid
GA000334386DMedicaid
GA000334389GMedicaid