Provider Demographics
NPI:1235322033
Name:NORTHEAST INFECTIOUS DISEASES INC
Entity Type:Organization
Organization Name:NORTHEAST INFECTIOUS DISEASES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-376-4252
Mailing Address - Street 1:601 PROFESSIONAL DR # A
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7698
Mailing Address - Country:US
Mailing Address - Phone:678-376-4252
Mailing Address - Fax:678-376-4253
Practice Address - Street 1:601 PROFESSIONAL DR # A
Practice Address - Street 2:SUITE 340
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7698
Practice Address - Country:US
Practice Address - Phone:678-376-4252
Practice Address - Fax:678-376-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI38004Medicare UPIN