Provider Demographics
NPI:1497702872
Name:KRISHNAMURTHY, VIDYA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:
Last Name:KRISHNAMURTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIDYA
Other - Middle Name:
Other - Last Name:KASINATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3180 N POINT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4381
Mailing Address - Country:US
Mailing Address - Phone:770-346-0132
Mailing Address - Fax:770-346-0165
Practice Address - Street 1:3180 N POINT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4381
Practice Address - Country:US
Practice Address - Phone:770-346-0132
Practice Address - Fax:770-346-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057528207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA553342565AMedicaid