Provider Demographics
NPI:1760487920
Name:DHRUVA, NIMISH NARESH (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMISH
Middle Name:NARESH
Last Name:DHRUVA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1267 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2114
Mailing Address - Country:US
Mailing Address - Phone:770-716-0051
Mailing Address - Fax:770-716-0087
Practice Address - Street 1:1267 HIGHWAY 54 W
Practice Address - Street 2:SUITE 2200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2114
Practice Address - Country:US
Practice Address - Phone:770-716-0051
Practice Address - Fax:770-716-0087
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA045200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000784946KMedicaid
G37102Medicare UPIN
GA202I063066Medicare PIN