Provider Demographics
NPI:1104884220
Name:ENDOCRINE & DIABETES CONSULTANTS, PC
Entity type:Organization
Organization Name:ENDOCRINE & DIABETES CONSULTANTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHYAMA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:770-389-0200
Mailing Address - Street 1:226 WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7272
Mailing Address - Country:US
Mailing Address - Phone:770-389-0200
Mailing Address - Fax:770-474-1570
Practice Address - Street 1:226 WILLIS DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7272
Practice Address - Country:US
Practice Address - Phone:770-389-0200
Practice Address - Fax:770-474-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP549Medicare PIN