Healthcare Provider Details

I. General information

NPI: 1073089561
Provider Name (Legal Business Name): RADHIKA KADAKIA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

IV. Provider business mailing address

1865 HAYS FARM WALK
MARIETTA GA
30064-5477
US

V. Phone/Fax

Practice location:
  • Phone: 47-859-6504
  • Fax:
Mailing address:
  • Phone: 404-579-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN249752
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN249752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: