Provider Demographics
NPI:1598714479
Name:VASANTHAKUMAR, SINNATHURAI (MD)
Entity Type:Individual
Prefix:
First Name:SINNATHURAI
Middle Name:
Last Name:VASANTHAKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 DAN PROCTOR DR
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ST MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558
Mailing Address - Country:US
Mailing Address - Phone:912-882-6767
Mailing Address - Fax:912-882-6411
Practice Address - Street 1:2060 DAN PROCTOR DR
Practice Address - Street 2:SUITE 2100
Practice Address - City:ST MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-882-6767
Practice Address - Fax:912-882-6411
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044131173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG58865Medicare UPIN