Provider Demographics
NPI:1184948549
Name:KANJI, MUKTI BHATIA (DO)
Entity type:Individual
Prefix:PROF
First Name:MUKTI
Middle Name:BHATIA
Last Name:KANJI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 YORKTOWN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1568
Mailing Address - Country:US
Mailing Address - Phone:770-460-4285
Mailing Address - Fax:770-460-4319
Practice Address - Street 1:101 YORKTOWN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1568
Practice Address - Country:US
Practice Address - Phone:770-460-4285
Practice Address - Fax:770-460-4319
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA055836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine