Provider Demographics
NPI:1356425136
Name:MUKERJI, NIRVAN (MD)
Entity type:Individual
Prefix:
First Name:NIRVAN
Middle Name:
Last Name:MUKERJI
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 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:404-696-0509
Practice Address - Street 1:2525 CUMBERLAND PKWY SE
Practice Address - Street 2:KAISER PERMANENTE CUMBERLAND MEDICAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3915
Practice Address - Country:US
Practice Address - Phone:404-606-0122
Practice Address - Fax:404-696-0509
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20060164207R00000X
GA060675207R00000X, 207RN0300X
NC200601614208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI66757Medicare UPIN