Basic Information
| Provider Information | |||||||||
| NPI: | 1689161903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANDYA | ||||||||
| FirstName: | NEERALI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 CANTON RD NE STE 300 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300608949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787415000 | ||||||||
| FaxNumber: | 6788194280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1365 CLIFTON RD NE BLDG B | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303228949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8553667989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2018 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 008715 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 8715 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.