Provider Demographics
NPI:1730183377
Name:NATH, VIJAY (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:STE 460
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1171
Mailing Address - Country:US
Mailing Address - Phone:770-427-7389
Mailing Address - Fax:770-427-2845
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:STE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1171
Practice Address - Country:US
Practice Address - Phone:770-427-7389
Practice Address - Fax:770-427-2845
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO055690174400000X
GAGA055690207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA437284962KMedicaid
GA437284962VMedicaid
GA437284962GMedicaid
GA437284962FMedicaid
GA437284962HMedicaid
GA437284962UMedicaid
GA437284962JMedicaid
GA437284962BMedicaid
GA437284962CMedicaid
GA437284962PMedicaid
GA437284962RMedicaid
GA437284962AMedicaid
GA437284962DMedicaid
GA437284962EMedicaid
GA437284962QMedicaid
GA437284962SMedicaid
GA437284962LMedicaid
GA437284962NMedicaid
GA437284962OMedicaid
GA437284962TMedicaid
GA437284962VMedicaid
GA11SCDXTMedicare PIN