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NPI Code Detail

MEDICARE: SUDHEER BALAKRISHNAN M.D.

MEDICARE: SUDHEER BALAKRISHNAN M.D.
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
12085R0202XDiagnostic Radiology Physician92704GA
2390200000XStudent in an Organized Health Care Education/Training Program0116022352VA

General Provider Information

NPI Number : 1770803983
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUDHEER BALAKRISHNAN M.D.
Provider Business Mailing Address
First Line : 693 PEACHTREE ST NE APT 23D
Second Line :
City : ATLANTA
State : GA
Zip : 30308-4149
Country : US
Telephone Number : 301-787-2185
Fax Number :
Provider Business Practice Location Address
First Line : 80 JESSE HILL JR DR SE FL 3
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3050
Country : US
Telephone Number : 404-616-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2010
Last Update Date : 07/26/2022

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