Provider Demographics
NPI:1932468287
Name:ENDOCRINOLOGY AND DIABETES OF GEORGIA, P.C
Entity Type:Organization
Organization Name:ENDOCRINOLOGY AND DIABETES OF GEORGIA, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYASUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-335-0413
Mailing Address - Street 1:715 BARNESLEY LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3773
Mailing Address - Country:US
Mailing Address - Phone:770-335-0413
Mailing Address - Fax:
Practice Address - Street 1:11912 JONES BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-4613
Practice Address - Country:US
Practice Address - Phone:678-358-5360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty