Provider Demographics
NPI:1578670071
Name:DESAI, ANIL J (MD)
Entity type:Individual
Prefix:MR
First Name:ANIL
Middle Name:J
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3641 HIGHWAY 20 SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-3064
Mailing Address - Country:US
Mailing Address - Phone:770-918-1234
Mailing Address - Fax:770-918-1235
Practice Address - Street 1:4139 BAKER ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1405
Practice Address - Country:US
Practice Address - Phone:770-786-9499
Practice Address - Fax:770-786-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-02-25
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Provider Licenses
StateLicense IDTaxonomies
GA035033207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00588266CMedicaid
GA00588266CMedicaid
GA83BBBFPMedicare ID - Type Unspecified