Provider Demographics
NPI:1669585022
Name:DHOLAKIA, BHAIRAVI KHAROD (MD)
Entity type:Individual
Prefix:
First Name:BHAIRAVI
Middle Name:KHAROD
Last Name:DHOLAKIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 JESSE JEWELL PKWY NE
Mailing Address - Street 2:STE 100
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3801
Mailing Address - Country:US
Mailing Address - Phone:770-534-1711
Mailing Address - Fax:770-534-9158
Practice Address - Street 1:1230 BALD RIDGE MARINA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7536
Practice Address - Country:US
Practice Address - Phone:770-292-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66279207W00000X
ARE-5393207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I183995Medicare PIN
NC2057725Medicare PIN
AR07110012400OtherQUAL CHOICE
AR166276001Medicaid
AR5H027Medicare PIN