MEDICARE: MRS. PREMA V SANNE 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	2084P0800X	Psychiatry Physician	047941	GA
2	2084P0800X	Psychiatry Physician	C161449	CA

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

General Provider Information

NPI Number	:	1982686838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PREMA V SANNE MD

Provider Business Mailing Address
First Line	:	1009 RIVER POINTE DR
Second Line	:	1009
City	:	ALBANY
State	:	GA
Zip	:	31701-4763
Country	:	US
Telephone Number	:	229-869-0683
Fax Number	:	229-889-7393

Provider Business Practice Location Address
First Line	:	4441 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93702-3604
Country	:	US
Telephone Number	:	559-253-9521
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/18/2021

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