Basic Information
| Provider Information | |||||||||
| NPI: | 1053571117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVANI | ||||||||
| FirstName: | ATUL | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S MADISON ST | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317925473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292360831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 462 ELMA G MILES PKWY STE 102A | ||||||||
| Address2: | |||||||||
| City: | HINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123699313 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 02/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 066590 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 624838 | 01 | GA | WELLCARE | OTHER | GA1242 | 05 | SC | MEDICAID | 003112641A | 05 | GA | MEDICAID | 003112641B | 05 | GA | MEDICAID | 003112641C | 05 | GA | MEDICAID | P01003836 | 01 | GA | RAILROAD MEDICARE | OTHER |