Provider Demographics
NPI:1922307610
Name:BANU ANAM, SHARMIN (MD)
Entity Type:Individual
Prefix:
First Name:SHARMIN
Middle Name:
Last Name:BANU ANAM
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 1:3400 OLD MILTON PKWY
Mailing Address - Street 2:STE C270
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4414
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:770-663-8905
Practice Address - Street 1:4235 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6038
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:678-802-5765
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71957207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine