Provider Demographics
NPI:1629132907
Name:CHEEKATI, SUDHA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:M
Last Name:CHEEKATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5110 PARK BROOKE WALK WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3404
Mailing Address - Country:US
Mailing Address - Phone:404-778-5220
Mailing Address - Fax:404-778-6451
Practice Address - Street 1:1845 SATELLITE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4061
Practice Address - Country:US
Practice Address - Phone:404-778-5220
Practice Address - Fax:404-778-6451
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053985OtherSTATE LICENSE
GA11SCHMPMedicare PIN
GA053985OtherSTATE LICENSE
GAI 12059Medicare UPIN