Provider Demographics
NPI:1487896288
Name:DESAI, PRANAV JITENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:PRANAV
Middle Name:JITENDRA
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 BELFAIRE LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6785
Mailing Address - Country:US
Mailing Address - Phone:678-749-4700
Mailing Address - Fax:
Practice Address - Street 1:5665 NEW NORTHSIDE DR NW
Practice Address - Street 2:SUITE 320
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5831
Practice Address - Country:US
Practice Address - Phone:770-874-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2283207P00000X
CAA142981207P00000X
GA67412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine