Provider Demographics
NPI:1770045015
Name:SUDHI, SUSHMA (DO)
Entity Type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:SUDHI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 DIXIE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3889
Mailing Address - Country:US
Mailing Address - Phone:770-812-8640
Mailing Address - Fax:770-838-8650
Practice Address - Street 1:706 DIXIE ST STE 210
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3889
Practice Address - Country:US
Practice Address - Phone:770-812-8640
Practice Address - Fax:770-838-8650
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91782208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics