Provider Demographics
NPI:1689328304
Name:ADSIDE, INDIA
Entity Type:Individual
Prefix:MS
First Name:INDIA
Middle Name:
Last Name:ADSIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 STEVEN DR APT 10204
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5877
Mailing Address - Country:US
Mailing Address - Phone:478-284-8229
Mailing Address - Fax:
Practice Address - Street 1:159 STEVEN DR APT 10204
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5877
Practice Address - Country:US
Practice Address - Phone:478-284-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory