Provider Demographics
NPI:1669607008
Name:GHOSE, NEENA DESAI (MD)
Entity type:Individual
Prefix:MRS
First Name:NEENA
Middle Name:DESAI
Last Name:GHOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEENA
Other - Middle Name:AJIT
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
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
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:215-923-9186
Practice Address - Street 1:200 CRESCENT CENTER PARKWAY
Practice Address - Street 2:KAISER PERMANENTE CRESCENT MEDICAL CENTER
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-496-3414
Practice Address - Fax:215-923-9186
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446165207Q00000X
390200000X
GA069119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program