Provider Demographics
NPI:1689685679
Name:PANDIRI, PAVANI KUMARI (MD)
Entity Type:Individual
Prefix:
First Name:PAVANI
Middle Name:KUMARI
Last Name:PANDIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAVANI
Other - Middle Name:
Other - Last Name:PANDIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 NORTHSIDE FORSYTH DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7659
Mailing Address - Country:US
Mailing Address - Phone:770-844-3200
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:1200 NORTHSIDE FORSYTH DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7659
Practice Address - Country:US
Practice Address - Phone:770-844-3200
Practice Address - Fax:404-851-6325
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048015207R00000X
GA48015208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH19594Medicare UPIN
GAH19594Medicare UPIN