Provider Demographics
NPI:1649279357
Name:DESAI, RAJENDRA C (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:C
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 1:2145 SLATER MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1205
Mailing Address - Country:US
Mailing Address - Phone:678-715-3334
Mailing Address - Fax:678-715-7477
Practice Address - Street 1:2145 SLATER MILL ROAD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1205
Practice Address - Country:US
Practice Address - Phone:678-715-3334
Practice Address - Fax:678-715-7477
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019253207RC0000X
GA19253207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000253228LMedicaid
D39732Medicare UPIN
GAD39732Medicare UPIN
GA511I060047Medicare PIN
GA000253228LMedicaid