Provider Demographics
NPI:1831150598
Name:NAYAK, KAMLESH DHIRUBHAI (MD)
Entity type:Individual
Prefix:
First Name:KAMLESH
Middle Name:DHIRUBHAI
Last Name:NAYAK
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 1:4904 TIMBER RIDGE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1826
Mailing Address - Country:US
Mailing Address - Phone:770-489-8165
Mailing Address - Fax:770-489-7884
Practice Address - Street 1:4904 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1826
Practice Address - Country:US
Practice Address - Phone:770-489-8165
Practice Address - Fax:770-489-7884
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032003207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA028737OtherBLUE CROSS
GA00517283CMedicaid
GA00517283CMedicaid
GAC48375Medicare UPIN