1598181943 NPI number — VIKAS NATH MD

Table of content: VIKAS NATH MD (NPI 1598181943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598181943 NPI number — VIKAS NATH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATH
Provider First Name:
VIKAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598181943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-1087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-464-5567
Provider Business Mailing Address Fax Number:
478-751-0455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-2981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-274-3825
Provider Business Practice Location Address Fax Number:
478-274-3254
Provider Enumeration Date:
03/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  036.141954 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 90143 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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