Provider Demographics
NPI:1083681589
Name:GOVIL, SANDEEP KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:KUMAR
Last Name:GOVIL
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:PO BOX 242113
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2113
Mailing Address - Country:US
Mailing Address - Phone:404-999-9999
Mailing Address - Fax:
Practice Address - Street 1:3969 S COBB DR SE
Practice Address - Street 2:SUITE 202
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:704-230-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054724207PE0004X
AL24493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBSGJMedicare ID - Type Unspecified
GAH67212Medicare UPIN