Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 85393 | GA |
N | 207VX0000X | Obstetrician | 85393 | GA |
NPI | 1619310984 |
---|---|
Provider Name | Shweta Desai |
First Address | Columbus, GA 31902-1914 |
Second Address | Roswell, GA 30076-4916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 15/09/2020 |