Provider Demographics
NPI:1730294125
Name:ATHNI, SUDHIR S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:S
Last Name:ATHNI
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 1:175 WATER TOWER CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4874
Mailing Address - Country:US
Mailing Address - Phone:478-471-6217
Mailing Address - Fax:478-471-8663
Practice Address - Street 1:175 WATER TOWER CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4874
Practice Address - Country:US
Practice Address - Phone:478-471-6217
Practice Address - Fax:478-471-8663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0403032084N0400X
TXH92732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00679291AMedicaid
GA13BDCMTMedicare ID - Type Unspecified
GAF98241Medicare UPIN