Provider Demographics
NPI:1861657835
Name:OOMMEN, ANJU ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANJU
Middle Name:ANNA
Last Name:OOMMEN
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 1:7107 RENAISSANCE WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2474
Mailing Address - Country:US
Mailing Address - Phone:404-704-5488
Mailing Address - Fax:
Practice Address - Street 1:720 WESTVIEW DRIVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1495
Practice Address - Country:US
Practice Address - Phone:404-752-1857
Practice Address - Fax:404-752-1088
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003446207R00000X
GA066386207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine