1952596850 NPI number — DR. SONNY SANDEEP SINGH DOSANJH MD

Table of content: DR. SONNY SANDEEP SINGH DOSANJH MD (NPI 1952596850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952596850 NPI number — DR. SONNY SANDEEP SINGH DOSANJH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOSANJH
Provider First Name:
SONNY
Provider Middle Name:
SANDEEP SINGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOSANJH
Provider Other First Name:
SANDEEP
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1952596850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 GEORGE BUSBEE PKWY NW
Provider Second Line Business Mailing Address:
SUITE 50
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-6908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 GEORGE BUSBEE PKWY NW
Provider Second Line Business Practice Location Address:
SUITE 50
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-6908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-328-4624
Provider Business Practice Location Address Fax Number:
770-882-2576
Provider Enumeration Date:
09/13/2007

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: 208100000X , with the licence number:  066686 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , with the licence number: 66686 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 03136770D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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