Provider Demographics
NPI:1407845340
Name:PODDAR, ARCHNA (MD)
Entity Type:Individual
Prefix:
First Name:ARCHNA
Middle Name:
Last Name:PODDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2878 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:STE 2A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5896
Mailing Address - Country:US
Mailing Address - Phone:678-344-8700
Mailing Address - Fax:678-344-8600
Practice Address - Street 1:2878 FIVE FORKS TRICKUM RD
Practice Address - Street 2:STE 2A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5896
Practice Address - Country:US
Practice Address - Phone:678-344-8700
Practice Address - Fax:678-344-8600
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA494286Medicare UPIN
GA11BDXDFMedicare ID - Type Unspecified