Provider Demographics
NPI:1073523247
Name:ADULLA, MADHURIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHURIMA
Middle Name:
Last Name:ADULLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 DULUTH HWY STE 801
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8709
Mailing Address - Country:US
Mailing Address - Phone:470-325-0148
Mailing Address - Fax:770-339-0485
Practice Address - Street 1:665 DULUTH HWY STE 401
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4303
Practice Address - Country:US
Practice Address - Phone:678-312-0450
Practice Address - Fax:770-339-2135
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45830-020207R00000X
GA057035207R00000X
GA57035207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90857Medicare UPIN