Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 66476 | GA |
N | 111NI0900X | Internist | 66476 | GA |
Y | 207RN0300X | Nephrologist | 66476 | GA |
NPI | 1063679769 |
---|---|
Provider Name | Niraj Desai |
First Address | Macon, GA 31201-3206 |
Second Address | Macon, GA 31201-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 06/07/2011 |