Provider Demographics
NPI:1821212390
Name:GHIA, AMITA KETAN (MD)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:KETAN
Last Name:GHIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 MORNINGDALE CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5260
Mailing Address - Country:US
Mailing Address - Phone:678-473-0715
Mailing Address - Fax:
Practice Address - Street 1:2320 ATLANTA HWY
Practice Address - Street 2:STE 105
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6339
Practice Address - Country:US
Practice Address - Phone:770-203-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine