Provider Demographics
NPI:1780114975
Name:BODA, SUSHANTH RAGHU (DO)
Entity type:Individual
Prefix:DR
First Name:SUSHANTH
Middle Name:RAGHU
Last Name:BODA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 HIGHWAY 34 E STE C
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6407
Mailing Address - Country:US
Mailing Address - Phone:678-971-4167
Mailing Address - Fax:
Practice Address - Street 1:3231 HIGHWAY 34 E STE C
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6407
Practice Address - Country:US
Practice Address - Phone:678-971-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125071636207L00000X
MA271781207L00000X
GA92204207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty