Provider Demographics
NPI:1063562700
Name:AARTI PANDYA, M.D., P.C.
Entity type:Organization
Organization Name:AARTI PANDYA, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-929-1333
Mailing Address - Street 1:1309 MILSTEAD ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012
Mailing Address - Country:US
Mailing Address - Phone:770-929-1333
Mailing Address - Fax:770-929-0659
Practice Address - Street 1:1309 MILSTEAD ROAD
Practice Address - Street 2:STE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:770-929-1333
Practice Address - Fax:770-929-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020985207W00000X
GA047501207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000832785AOtherMD
GA000188394DMedicaid
GA000832785AMedicaid
1316916646OtherNPI
H00749OtherUPIN
18B0FPCOtherMC
207W00000XOtherTAXONOMY CODE
1497724447OtherNPI
GA047501OtherLICENSE #
GAH00749Medicare UPIN
GA047501OtherLICENSE #
GA000832785AMedicaid
GA000188394DMedicaid