Healthcare Provider Details

I. General information

NPI: 1548383896
Provider Name (Legal Business Name): KOMAL SAHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 CLIFTON RD NE
ATLANTA GA
30329-4021
US

IV. Provider business mailing address

5216 AFTON WAY SE
SMYRNA GA
30080-2672
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-4585
  • Fax: 404-728-4931
Mailing address:
  • Phone: 770-333-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT001763
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: