Provider Demographics
NPI:1124196191
Name:SINHA, SANJAY KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:KUMAR
Last Name:SINHA
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 1:627 DAHOMA TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3628
Mailing Address - Country:US
Mailing Address - Phone:770-516-6173
Mailing Address - Fax:
Practice Address - Street 1:696 GRAYSON HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6372
Practice Address - Country:US
Practice Address - Phone:770-963-0927
Practice Address - Fax:770-963-9772
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF47316Medicare UPIN