Provider Demographics
NPI:1811040942
Name:DESAI, BIREN B (MD)
Entity Type:Individual
Prefix:
First Name:BIREN
Middle Name:B
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-851-6325
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36849207R00000X
GA051925208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200472280AMedicaid
KY64059165Medicaid
1171845OtherPASSPORT
P00050427OtherRAILROAD MEDICARE
7499402OtherAETNA
000000300762OtherANTHEM BCBS
0401851OtherUNITED HEALTHCARE
2440912000OtherPASSPORT ADVANTAGE
GA003181958AMedicaid
203411900OtherUSDOL
1171845OtherPASSPORT