Provider Demographics
NPI:1134135809
Name:LINGATLU, SUJATHA (MD)
Entity Type:Individual
Prefix:
First Name:SUJATHA
Middle Name:
Last Name:LINGATLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUJATHA
Other - Middle Name:
Other - Last Name:BIRIDEPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 769609
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8224
Mailing Address - Country:US
Mailing Address - Phone:678-990-1831
Mailing Address - Fax:675-990-1835
Practice Address - Street 1:3135 MATHIS AIRPORT PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9134
Practice Address - Country:US
Practice Address - Phone:770-886-7711
Practice Address - Fax:770-886-7698
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA348016565BMedicaid
GA348016565DMedicaid
GA1609816123OtherGEORGIA CLINIC PC GROUP NPI #
GA348016565AMedicaid
GA348016565EMedicaid
GA348016565BMedicaid
GA202I084366Medicare PIN