Healthcare Provider Details

I. General information

NPI: 1053767319
Provider Name (Legal Business Name): VARUN PATTISAPU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW STE 500
ATLANTA GA
30309-1711
US

IV. Provider business mailing address

8700 BEVERLY BLVD #5512
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number100161
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA155347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: