Provider Demographics
NPI:1659583938
Name:SHANMUGA SUNDARA PERUMAL, SATHISH KANNAN (MD)
Entity Type:Individual
Prefix:
First Name:SATHISH
Middle Name:KANNAN
Last Name:SHANMUGA SUNDARA PERUMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SATHISH
Other - Middle Name:
Other - Last Name:PERUMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:470-271-3418
Mailing Address - Fax:
Practice Address - Street 1:361 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3659
Practice Address - Country:US
Practice Address - Phone:912-355-6221
Practice Address - Fax:912-355-6914
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12946OtherNV MEDICAL LICENSE #
NV12946OtherNV MEDICAL LICENSE #