Provider Demographics
NPI:1073833265
Name:SOODJINDA, VARACHATI (MD)
Entity Type:Individual
Prefix:DR
First Name:VARACHATI
Middle Name:
Last Name:SOODJINDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 POST WOODS DR
Mailing Address - Street 2:#B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3498
Mailing Address - Country:US
Mailing Address - Phone:404-988-4262
Mailing Address - Fax:
Practice Address - Street 1:592 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2055
Practice Address - Country:US
Practice Address - Phone:770-374-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL980767OtherUPIN