Provider Demographics
NPI:1518086081
Name:SAI MEDICAL CLINIC,P.C
Entity Type:Organization
Organization Name:SAI MEDICAL CLINIC,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAVANI
Authorized Official - Middle Name:KUMARI
Authorized Official - Last Name:PANDIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-797-3989
Mailing Address - Street 1:4940 BANKSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2691
Mailing Address - Country:US
Mailing Address - Phone:770-797-3989
Mailing Address - Fax:770-797-9592
Practice Address - Street 1:4500 HUGH HOWELL RD
Practice Address - Street 2:STE# 110
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4723
Practice Address - Country:US
Practice Address - Phone:770-414-5588
Practice Address - Fax:770-414-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048015261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH19594Medicare UPIN
GAGRP7526Medicare ID - Type UnspecifiedSAI MEDICAL CLINIC , P.C.
GA11SCFVJMedicare ID - Type UnspecifiedPAVANI PANDIRI, M.D.