| Mahantkeshavjivandas Llc | |
|
11175 Cicero Dr Ste 140 Alpharetta GA 30022-1179 | |
| (404) 835-1575 | |
| (404) 835-1535 |
| Full Name | Mahantkeshavjivandas Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11175 Cicero Dr Ste 140, Alpharetta, Georgia |
| Authorized Official Name and Position | Kinjal Ghelani (MEMBER MANAGER) |
| Authorized Official Contact | 4048351575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mahantkeshavjivandas Llc 11175 Cicero Dr Ste 140 Alpharetta GA 30022-1179 Ph: (404) 835-1575 | Mahantkeshavjivandas Llc 11175 Cicero Dr Ste 140 Alpharetta GA 30022-1179 Ph: (404) 835-1575 |
| NPI Number | 1952900326 |
|---|---|
| Provider Enumeration Date | 10/18/2020 |
| Last Update Date | 08/24/2023 |
| Certification Date | 08/24/2023 |
| Medicare PECOS PAC ID | 9537579230 |
|---|---|
| Medicare Enrollment ID | O20201109002505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952900326 | NPI | - | NPPES |
| 1457517898 | Medicaid | TN | |
| 1083970701 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Kinjal Ghelani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083970701 PECOS PAC ID: 3971753732 Enrollment ID: I20201109002595 |
| Provider Name | Janak H Ghelani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457517898 PECOS PAC ID: 3870743636 Enrollment ID: I20201111002651 |
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