Provider Demographics
NPI:1356711790
Name:NAGATHIL, ROSHINI GANGADHARAN
Entity type:Individual
Prefix:MRS
First Name:ROSHINI
Middle Name:GANGADHARAN
Last Name:NAGATHIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 VINTAGE CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4509
Mailing Address - Country:US
Mailing Address - Phone:678-860-8160
Mailing Address - Fax:770-437-8411
Practice Address - Street 1:2900 CUMBERLAND MALL SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-8107
Practice Address - Country:US
Practice Address - Phone:770-431-1709
Practice Address - Fax:770-431-1706
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARXPH027602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist