Provider Demographics
NPI:1063013993
Name:SINHA, JYOTI
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:SINHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 BIRKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5232
Mailing Address - Country:US
Mailing Address - Phone:336-671-3495
Mailing Address - Fax:
Practice Address - Street 1:3655 BROWNS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-4134
Practice Address - Country:US
Practice Address - Phone:770-203-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist