Provider Demographics
NPI:1780768192
Name:ANANTHAKRISHNAN, DHEERA (MD)
Entity type:Individual
Prefix:DR
First Name:DHEERA
Middle Name:
Last Name:ANANTHAKRISHNAN
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 1:59 EXECUTIVE PARK SOUTH
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-778-6306
Mailing Address - Fax:404-778-6376
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH
Practice Address - Street 2:SUITE 3000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-778-6306
Practice Address - Fax:404-778-6376
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042731207X00000X
GA059591207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8374316Medicaid
WA8374316Medicaid