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Organization

NIRANJAN J DAVE MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NIRANJAN J DAVE MD (OWNER)
(770) 944-2245
Entity
Organization

Contact information

Practice address
3825 MEDICAL PARK DR, SUITE 100, AUSTELL, GA 30106-6831
(770) 944-2245
(770) 944-1337
Mailing address
3825 MEDICAL PARK DR, SUITE 100, AUSTELL, GA 30106-6831
(770) 944-2245
(770) 944-1337

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
031232
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000405402D
GA
01
003114146A
MEDICAID PAYEE ID
Enumeration date
04/18/2012
Last updated
11/13/2013
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