Provider Demographics
NPI:1306191820
Name:MUSTY, PRANEETHA (MBBS/MD)
Entity Type:Individual
Prefix:
First Name:PRANEETHA
Middle Name:
Last Name:MUSTY
Suffix:
Gender:F
Credentials:MBBS/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 ATLANTA RD SE STE 315
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6443
Mailing Address - Country:US
Mailing Address - Phone:770-333-2035
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 315
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6443
Practice Address - Country:US
Practice Address - Phone:770-333-2035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308167207RR0500X
GA95355207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology