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Individual

SHIVAM DESAI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4904 TIMBER RIDGE DR STE 102, DOUGLASVILLE, GA 30135-1831
(678) 401-4597
Mailing address
4650 SMOKESTONE DR, DOUGLASVILLE, GA 30135-4989
(678) 521-0935

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
83654
GA

Other

Enumeration date
04/05/2017
Last updated
03/25/2023
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