Provider Demographics
NPI:1760427496
Name:SATHANANDAN, SUMATHIRA T (MD)
Entity Type:Individual
Prefix:
First Name:SUMATHIRA
Middle Name:T
Last Name:SATHANANDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WEST FOREST,
Mailing Address - Street 2:STE 200
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301
Mailing Address - Country:US
Mailing Address - Phone:731-541-9490
Mailing Address - Fax:731-541-9485
Practice Address - Street 1:700 WEST FOREST,
Practice Address - Street 2:STE. 200
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-541-9490
Practice Address - Fax:731-541-9485
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS188022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159702001Medicaid
LA1593656Medicaid
MS03838021Medicaid
I26887Medicare UPIN
MS03838021Medicaid