Provider Demographics
NPI:1770551822
Name:DESAI, NAZNEEN S (MD)
Entity type:Individual
Prefix:DR
First Name:NAZNEEN
Middle Name:S
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4243 DUNWOODY CLUB DR STE 103
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5206
Mailing Address - Country:US
Mailing Address - Phone:678-336-5255
Mailing Address - Fax:678-336-5259
Practice Address - Street 1:4243 DUNWOODY CLUB DR STE 103
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:678-336-5255
Practice Address - Fax:678-336-5259
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA048858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00945051AMedicaid
GA000945051BMedicaid