Healthcare Provider Details

I. General information

NPI: 1588943856
Provider Name (Legal Business Name): VAIDEHI AVADHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 06/09/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHYSICIANS PROFESSIONAL LABORA 5665 PEACHTREE DUNWOODY ROAD
ATLANTA GA
30342-1701
US

IV. Provider business mailing address

PATHOLOGY AND LABORATORY MEDICINE EMORY UNI ROOM H183, 1364 CLIFTON ROAD NE,
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-7001
  • Fax:
Mailing address:
  • Phone: 404-727-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number77934
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number77934
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: