Provider Demographics
NPI:1265486203
Name:CHAUDHRY, SUNDEEP - (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNDEEP
Middle Name:-
Last Name:CHAUDHRY
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 1:1670 RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1541
Mailing Address - Country:US
Mailing Address - Phone:404-966-1670
Mailing Address - Fax:404-320-9432
Practice Address - Street 1:1117 PERIMETER CTR W
Practice Address - Street 2:W-211
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5451
Practice Address - Country:US
Practice Address - Phone:678-636-3062
Practice Address - Fax:678-636-3086
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00846282AMedicaid
GABK5829796OtherDEA NUMBER
GAG98363Medicare UPIN
GA11BDQKBMedicare ID - Type UnspecifiedPROVIDER NUMBER