1639354434 NPI number — TANYA OBEROI PANDYA D.O., M.B.A.

Table of content: TANYA OBEROI PANDYA D.O., M.B.A. (NPI 1639354434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639354434 NPI number — TANYA OBEROI PANDYA D.O., M.B.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANDYA
Provider First Name:
TANYA
Provider Middle Name:
OBEROI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O., M.B.A.
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:
1639354434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7690 SAINT MARLO COUNTRY CLUB PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30097-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-984-3151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3925 JOHNS CREEK CT
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-6618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-709-6922
Provider Business Practice Location Address Fax Number:
770-709-6910
Provider Enumeration Date:
12/31/2007

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: 207Q00000X , with the licence number:  001584 , 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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