Provider Demographics
NPI:1043414196
Name:NORTH GEORGIA DIABETES AND ENDOCRINOLOGY
Entity Type:Organization
Organization Name:NORTH GEORGIA DIABETES AND ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETHA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:SOODINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-749-2131
Mailing Address - Street 1:11585 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 420-127
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:SUITE 2800
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:678-749-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059025207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty