Healthcare Provider Details

I. General information

NPI: 1770803199
Provider Name (Legal Business Name): MANU SURAJ SANCHETI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD SUITE 200
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD SUITE 200
ATLANTA GA
30342-1764
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-7200
  • Fax: 404-778-6626
Mailing address:
  • Phone: 404-778-7200
  • Fax: 404-778-6626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number247474
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number67158
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: