Provider Demographics
NPI:1093005852
Name:SAMBHARA, VIVEK SUNNY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:SUNNY
Last Name:SAMBHARA
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 1:1240 JESSE JEWELL PKWY SE STE 500
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3861
Mailing Address - Country:US
Mailing Address - Phone:770-536-9864
Mailing Address - Fax:770-297-5023
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE STE 500
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:770-297-5023
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36045207R00000X, 207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I299613OtherMEDICARE
AL204841Medicaid
AL6463776OtherUHC
AL512-06467OtherBCBS
AL200249Medicaid
AL213772Medicaid
AL200675Medicaid
AL511-93687OtherBCBS
MS7622791OtherMS MEDICAID
AL512-06466OtherBCBS
ALP01910365OtherRR MEDICARE
AL202291Medicaid
AL214102Medicaid
AL511-93686OtherBCBS
AL511-98462OtherBCBS
AL8075988OtherCIGNA HC
AL4678634OtherAETNA
AL511-93688OtherBCBS
ALZ49093OtherVIVA HEALTH