Provider Demographics
NPI:1376022434
Name:BHATIA, NEENA
Entity Type:Individual
Prefix:
First Name:NEENA
Middle Name:
Last Name:BHATIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 FULHAM CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8042
Mailing Address - Country:US
Mailing Address - Phone:678-200-5468
Mailing Address - Fax:
Practice Address - Street 1:3195 BUFORD HWY STE 1
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5707
Practice Address - Country:US
Practice Address - Phone:678-243-5021
Practice Address - Fax:678-243-5020
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230108363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty