Individual
MINI JOSEPH SHIVPRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5023
Mailing address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5023
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
57493
GA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
57493
GA
Other
Enumeration date
01/19/2006
Last updated
03/09/2021
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