Provider Demographics
NPI:1770682825
Name:LODHI, SUNDUS (MD)
Entity Type:Individual
Prefix:
First Name:SUNDUS
Middle Name:
Last Name:LODHI
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 1:3900 POWERS FERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4026
Mailing Address - Country:US
Mailing Address - Phone:832-452-1035
Mailing Address - Fax:
Practice Address - Street 1:35 COLLIER RD NW STE M200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1673
Practice Address - Country:US
Practice Address - Phone:678-686-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65021207RN0300X
TXM4862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188677201Medicaid
TX8W6310OtherBCBSTX
I67117Medicare UPIN
TX8J1124Medicare PIN