Provider Demographics
NPI:1891985024
Name:SOOD, PRAN N (MD)
Entity Type:Individual
Prefix:
First Name:PRAN
Middle Name:N
Last Name:SOOD
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 1:1287 HWY 138 SPUR 8
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2419
Mailing Address - Country:US
Mailing Address - Phone:770-473-0038
Mailing Address - Fax:770-471-4290
Practice Address - Street 1:1287 HWY 138 SPUR 8
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-473-0038
Practice Address - Fax:770-471-4290
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021593208VP0014X, 207XX0801X
332B00000X
GA1871553297208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20BDCKNMedicare PIN
GAC03542Medicare UPIN