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Provider Information for 1992180111



SARANYADEVI SAKTHIVADIVEL

Gender: FEMALE

Individual NPI: 1992180111

Calendar Last Updated: 2015-07-29

Details

Name Value
NPI 1992180111
Enumeration Date 2015-07-29
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 478 LINDBERGH PL NE APT. NO. 262
ATLANTA, GA 30324-3313
United States

Phone: 267-283-8288 | Fax:
View Map External Link
Primary Practice Address 4450 HUGH HOWELL RD SUITE #19
TUCKER, GA 30084-4727
United States

Phone: 770-938-9090 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice GA DN015061