1154443091 NPI number — DR. KARTHI SUBBANNAN M.D

Table of content: DR. KARTHI SUBBANNAN M.D (NPI 1154443091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154443091 NPI number — DR. KARTHI SUBBANNAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBBANNAN
Provider First Name:
KARTHI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154443091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 SAVOY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30341-1072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-623-8965
Provider Business Mailing Address Fax Number:
770-623-4018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 HOSPITAL PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-1982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-623-8965
Provider Business Practice Location Address Fax Number:
770-623-4018
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  062169 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 738700884D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 738700884C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".