Individual
PRAKASH V DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1664 MULKEY RD, AUSTELL, GA 30106-1114
(770) 941-7709
(770) 941-6441
Mailing address
1664 MULKEY RD, AUSTELL, GA 30106-1114
(770) 941-7709
(770) 941-6441
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
018482
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00132877A
—
GA
Enumeration date
12/15/2005
Last updated
09/15/2011
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