Provider Demographics
NPI:1992985741
Name:GEORGIA GENETICS, LLC
Entity type:Organization
Organization Name:GEORGIA GENETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-346-0132
Mailing Address - Street 1:3180 N POINT PKWY
Mailing Address - Street 2:SUITE202
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4248
Mailing Address - Country:US
Mailing Address - Phone:770-346-0132
Mailing Address - Fax:770-346-0165
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:SUITE202
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4248
Practice Address - Country:US
Practice Address - Phone:770-346-0132
Practice Address - Fax:770-346-0165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRICS & GENETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-09
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057528207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty