MEDICARE: DR. SUJATHA VIVEK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	058204	GA

General Provider Information

NPI Number	:	1013927003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUJATHA VIVEK MD

Provider Business Mailing Address
First Line	:	2685 PEACHTREE PKWY STE 300
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-1048
Country	:	US
Telephone Number	:	770-771-5270
Fax Number	:	770-771-5279

Provider Business Practice Location Address
First Line	:	2685 PEACHTREE PKWY STE 300
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-1048
Country	:	US
Telephone Number	:	770-771-5270
Fax Number	:	770-771-5279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	10/01/2021

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