Individual
PRAVIN CHIMANLAL MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
230D W COLLEGE ST, GRIFFIN, GA 30224-4121
(770) 229-6007
(770) 229-1518
Mailing address
230D W COLLEGE ST, GRIFFIN, GA 30224-4121
(770) 229-6007
(770) 229-1518
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
30028
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316391
BLUE CROSS
KY
05
—
64300288
—
KY
01
—
P00113101
TRAVELERS MEDICARE
—
Enumeration date
10/26/2005
Last updated
07/08/2007
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