Healthcare Provider Details

I. General information

NPI: 1629106679
Provider Name (Legal Business Name): UMA DHANABALAN MD, MPH, FAAFP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 BETHANY CHURCH RD
ALPHARETTA GA
30004-3217
US

IV. Provider business mailing address

777 CONCORD AVE STE 106
CAMBRIDGE MA
02138-1053
US

V. Phone/Fax

Practice location:
  • Phone: 508-444-2324
  • Fax: 504-340-4930
Mailing address:
  • Phone: 508-444-2324
  • Fax: 508-340-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number157551
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54183
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: