Basic Information
| Provider Information | |||||||||
| NPI: | 1225213804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | TEJAS | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5445 MERIDIAN MARKS RD | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303424763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048436320 | ||||||||
| FaxNumber: | 4048436321 | ||||||||
| Practice Location | |||||||||
| Address1: | 5445 MERIDIAN MARKS RD | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303424763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048436320 | ||||||||
| FaxNumber: | 4048436321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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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 | 2080P0206X | 057547 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 2080P0206X | ME104551 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
No ID Information.