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NPI Code Detail

MEDICARE: DR. ERIKA SANDRA VAN PUTTEN MD

MEDICARE: DR. ERIKA SANDRA VAN PUTTEN 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
12080A0000XPediatric Adolescent Medicine Physician055497GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538240353
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIKA SANDRA VAN PUTTEN MD
Provider Business Mailing Address
First Line : 3405 DALLAS HWY SW STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30064-6426
Country : US
Telephone Number : 770-425-5331
Fax Number : 770-425-0799
Provider Business Practice Location Address
First Line : 3405 DALLAS HWY SW STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30064-6426
Country : US
Telephone Number : 770-425-5331
Fax Number : 770-425-0799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 03/03/2014

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Directions to “ DR. ERIKA SANDRA VAN PUTTEN MD” Practice Location

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