Provider Demographics
NPI:1952753253
Name:MUDUNURU, SITARAMA ARVIND VARM (MD)
Entity Type:Individual
Prefix:
First Name:SITARAMA ARVIND VARM
Middle Name:
Last Name:MUDUNURU
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 1:275 COLLIER RD NW STE 290
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1700
Mailing Address - Country:US
Mailing Address - Phone:404-352-3300
Mailing Address - Fax:
Practice Address - Street 1:275 COLLIER RD NW STE 290
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1700
Practice Address - Country:US
Practice Address - Phone:404-352-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA87272207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program