Provider Demographics
NPI:1265538854
Name:CUDDAPAH, SATISH (MD)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:
Last Name:CUDDAPAH
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 1:2559 ACACIA PARK PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4768
Mailing Address - Country:US
Mailing Address - Phone:770-655-0312
Mailing Address - Fax:404-890-5587
Practice Address - Street 1:220 SANDY SPRINGS CIR NE
Practice Address - Street 2:SUITE 157A
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3816
Practice Address - Country:US
Practice Address - Phone:404-890-6064
Practice Address - Fax:404-890-5587
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10577030Medicare ID - Type Unspecified
H33564Medicare UPIN