Provider Demographics
NPI:1518223718
Name:SATHIYAKUMAR, ASMITHA KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:ASMITHA
Middle Name:KATHLEEN
Last Name:SATHIYAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 GLENN BLVD SW STE 343
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3533
Mailing Address - Country:US
Mailing Address - Phone:256-646-7246
Mailing Address - Fax:
Practice Address - Street 1:1403 OLD WATER WORKS RD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3353
Practice Address - Country:US
Practice Address - Phone:256-646-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075665207LP2900X
ALMD47655207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG041212248OtherMEDICARE PTAN
GAP02289708OtherRRMEDICARE PTAN
ALMD47655OtherALABAMA STATE LICENSE