Provider Demographics
NPI:1912951500
Name:SOUNDAPPAN, APPAVUCHETTY (MD)
Entity Type:Individual
Prefix:
First Name:APPAVUCHETTY
Middle Name:
Last Name:SOUNDAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2905
Mailing Address - Country:US
Mailing Address - Phone:478-988-3060
Mailing Address - Fax:478-988-3098
Practice Address - Street 1:1115 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2905
Practice Address - Country:US
Practice Address - Phone:478-988-3060
Practice Address - Fax:478-988-3098
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000779248EMedicaid
GA000779248FMedicaid
GA11BDVJKMedicare PIN
GA000779248EMedicaid