Provider Demographics
NPI:1578934501
Name:SUNSHINE PEDIATRICS OF GEORGIA,LLC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRICS OF GEORGIA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANDAMADHURI
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:CHUNDURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-239-5437
Mailing Address - Street 1:1485 PEACHTREE PKWY
Mailing Address - Street 2:SUITE D1
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-0500
Mailing Address - Country:US
Mailing Address - Phone:470-239-5437
Mailing Address - Fax:
Practice Address - Street 1:1485 PEACHTREE PKWY
Practice Address - Street 2:SUITE D1
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-0500
Practice Address - Country:US
Practice Address - Phone:470-239-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty