Healthcare Provider Details

I. General information

NPI: 1497702872
Provider Name (Legal Business Name): VIDYA KRISHNAMURTHY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIDYA KASINATHAN MD

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY STE 202
ALPHARETTA GA
30005-4381
US

IV. Provider business mailing address

3180 N POINT PKWY STE 202
ALPHARETTA GA
30005-4381
US

V. Phone/Fax

Practice location:
  • Phone: 770-346-0132
  • Fax: 770-346-0165
Mailing address:
  • Phone: 770-346-0132
  • Fax: 770-346-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number057528
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number057528
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: