Provider Demographics
NPI:1487683157
Name:MAKKAR, SARANDEEP K (MD, DO)
Entity Type:Individual
Prefix:
First Name:SARANDEEP
Middle Name:K
Last Name:MAKKAR
Suffix:
Gender:F
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:770-888-0763
Practice Address - Street 1:5440 HILLANDALE DR
Practice Address - Street 2:KAISER PERMANENTE PANOLA MEDICAL CENTER
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4865
Practice Address - Country:US
Practice Address - Phone:770-322-2777
Practice Address - Fax:770-888-0763
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058617204D00000X, 207Q00000X
ALDO-860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936721Medicaid
AL009936719Medicaid
AL51533396OtherBLUE CROSS
AL51533397OtherBLUE CROSS
AL51533400OtherBLUE CROSS
AL009935858Medicaid
AL009936722Medicaid
AL51533398OtherBLUE CROSS
AL51533398OtherBLUE CROSS
ALI11864Medicare UPIN