1134270440 NPI number — VARADA DINKAR DIVGI M.B.B.S. FAAP

Table of content: VARADA DINKAR DIVGI M.B.B.S. FAAP (NPI 1134270440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134270440 NPI number — VARADA DINKAR DIVGI M.B.B.S. FAAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIVGI
Provider First Name:
VARADA
Provider Middle Name:
DINKAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S. FAAP
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:
1134270440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4541 DEVONSHIRE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNWOODY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30338-5684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-455-9996
Provider Business Mailing Address Fax Number:
770-454-9419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4468 CHAMBLEE DUNWOODY RD
Provider Second Line Business Practice Location Address:
SUITE M3
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30338-6253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-455-9996
Provider Business Practice Location Address Fax Number:
770-454-9419
Provider Enumeration Date:
01/15/2007

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: 2080P0214X , with the licence number:  22747 , 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)