Healthcare Provider Details

I. General information

NPI: 1548260904
Provider Name (Legal Business Name): VAISHALI B KUTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 N POINT PKWY BLDG D STE 200
ALPHARETTA GA
30005-5481
US

IV. Provider business mailing address

4807 BLYTH CT
DUNWOODY GA
30338-5021
US

V. Phone/Fax

Practice location:
  • Phone: 770-667-6967
  • Fax: 866-578-7440
Mailing address:
  • Phone: 770-667-6967
  • Fax: 770-667-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number045526
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: