Healthcare Provider Details

I. General information

NPI: 1861657835
Provider Name (Legal Business Name): ANJU ANNA OOMMEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DRIVE SW
ATLANTA GA
30310-1495
US

IV. Provider business mailing address

7107 RENAISSANCE WAY NE
ATLANTA GA
30308-2474
US

V. Phone/Fax

Practice location:
  • Phone: 404-752-1857
  • Fax: 404-752-1088
Mailing address:
  • Phone: 404-704-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number003446
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number066386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: