Basic Information
| Provider Information | |||||||||
| NPI: | 1811040942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | BIREN | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4048516325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4048516325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2007 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36849 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 051925 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 200472280A | 05 | IN | MEDICAID | 64059165 | 05 | KY | MEDICAID | 1171845 | 01 | PASSPORT | OTHER | P00050427 | 01 | RAILROAD MEDICARE | OTHER | 7499402 | 01 | AETNA | OTHER | 000000300762 | 01 | ANTHEM BCBS | OTHER | 0401851 | 01 | UNITED HEALTHCARE | OTHER | 2440912000 | 01 | PASSPORT ADVANTAGE | OTHER | 003181958A | 05 | GA | MEDICAID | 203411900 | 01 | USDOL | OTHER |