Provider Demographics
NPI:1639127038
Name:CHAUDHURI, SWAPAN K (MD)
Entity Type:Individual
Prefix:
First Name:SWAPAN
Middle Name:K
Last Name:CHAUDHURI
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 1:143 CEDAR WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7769
Mailing Address - Country:US
Mailing Address - Phone:770-479-5222
Mailing Address - Fax:770-479-5222
Practice Address - Street 1:143 CEDAR WOODS TRL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7769
Practice Address - Country:US
Practice Address - Phone:770-479-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA283319021FMedicaid
GA283319021GMedicaid
GA283319021HMedicaid
GAP00832367OtherRAILROAD MEDICARE
G63610Medicare UPIN
GA283319021GMedicaid