Provider Demographics
NPI:1265722698
Name:PONNUSAMY, KARTHIKEYAN (MD)
Entity type:Individual
Prefix:
First Name:KARTHIKEYAN
Middle Name:
Last Name:PONNUSAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1505 STONE BRIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8282
Mailing Address - Country:US
Mailing Address - Phone:770-926-9112
Mailing Address - Fax:770-926-8240
Practice Address - Street 1:1505 STONE BRIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8282
Practice Address - Country:US
Practice Address - Phone:770-926-9112
Practice Address - Fax:770-926-8240
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV27416207X00000X
ZZ110573207X00000X
GA77758207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery