Healthcare Provider Details

I. General information

NPI: 1760700603
Provider Name (Legal Business Name): SUMIT VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2010
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 CHANTILLY DR NE
ATLANTA GA
30324-3267
US

IV. Provider business mailing address

1605 CHANTILLY DR NE
ATLANTA GA
30324-3267
US

V. Phone/Fax

Practice location:
  • Phone: 646-934-0936
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number047999
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number54856-020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number70448
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: