Provider Demographics
NPI:1841554185
Name:MURALIDHARA, SAMYUKTHA N (MD)
Entity type:Individual
Prefix:
First Name:SAMYUKTHA
Middle Name:N
Last Name:MURALIDHARA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:970 WOODSTOCK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4868
Mailing Address - Country:US
Mailing Address - Phone:678-388-5750
Mailing Address - Fax:678-388-5785
Practice Address - Street 1:970 WOODSTOCK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4868
Practice Address - Country:US
Practice Address - Phone:678-388-5750
Practice Address - Fax:678-388-5785
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA074842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine