MEDICARE: APPAVUCHETTY SOUNDAPPAN 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	207R00000X	Internal Medicine Physician	044107	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1912951500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APPAVUCHETTY SOUNDAPPAN MD

Provider Business Mailing Address
First Line	:	1115 MORNINGSIDE DR
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-2905
Country	:	US
Telephone Number	:	478-988-3060
Fax Number	:	478-988-3098

Provider Business Practice Location Address
First Line	:	1115 MORNINGSIDE DR
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-2905
Country	:	US
Telephone Number	:	478-988-3060
Fax Number	:	478-988-3098

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/03/2015

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