Provider Demographics
NPI:1366645699
Name:SACHDEVA, VINOD KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:KUMAR
Last Name:SACHDEVA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3830 SPALDING BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2300
Mailing Address - Country:US
Mailing Address - Phone:478-627-2120
Mailing Address - Fax:478-627-9427
Practice Address - Street 1:1412 PLUNKETT RD.
Practice Address - Street 2:DOOLY SP
Practice Address - City:UNADILLA
Practice Address - State:GA
Practice Address - Zip Code:31091
Practice Address - Country:US
Practice Address - Phone:478-627-2120
Practice Address - Fax:478-627-9427
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA046319207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA046319OtherSTATE LICENSE
GABS 6188177OtherDEA NO.
GA046319OtherSTATE LICENSE