Provider Demographics
NPI:1467649830
Name:PATTABIRAMAN, VIVEKANANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEKANANDA
Middle Name:
Last Name:PATTABIRAMAN
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 1:2779 STONE HALL DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5061
Mailing Address - Country:US
Mailing Address - Phone:862-485-3770
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1611
Practice Address - Country:US
Practice Address - Phone:404-303-3760
Practice Address - Fax:404-303-3759
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29763207R00000X
TN45291207R00000X
KS04-34597207R00000X
390200000X
GA065602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program