Provider Demographics
NPI:1134170996
Name:DAVE, NIRANJAN J (MD)
Entity type:Individual
Prefix:DR
First Name:NIRANJAN
Middle Name:J
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:SUITE 409
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:770-732-9100
Practice Address - Fax:770-528-9924
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-12-09
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Provider Licenses
StateLicense IDTaxonomies
GA031232207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C47451Medicare UPIN
GA003114146AOtherMEDICAID PAYEE ID
GA000391234BMedicaid
060018011OtherRAILROAD MCR
294077OtherBLUE CROSS
GA582129002OtherTIN NUMBER
GA06BDBRSMedicare ID - Type Unspecified