Provider Demographics
NPI:1508155854
Name:SAMPAT, RADHIKA (DO)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SAMPAT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 490
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8015
Mailing Address - Country:US
Mailing Address - Phone:678-538-2167
Mailing Address - Fax:678-538-2165
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 490
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:678-538-2167
Practice Address - Fax:678-538-2165
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA745442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology