1518086081 NPI number — SAI MEDICAL CLINIC,P.C

Table of content: (NPI 1518086081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518086081 NPI number — SAI MEDICAL CLINIC,P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAI MEDICAL CLINIC,P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1518086081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4940 BANKSIDE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30092-2691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-797-3989
Provider Business Mailing Address Fax Number:
770-797-9592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 HUGH HOWELL RD
Provider Second Line Business Practice Location Address:
STE# 110
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-414-5588
Provider Business Practice Location Address Fax Number:
770-414-0490
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PANDIRI
Authorized Official First Name:
PAVANI
Authorized Official Middle Name:
KUMARI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-797-3989

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  048015 , 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)





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