Healthcare Provider Details

I. General information

NPI: 1497250641
Provider Name (Legal Business Name): SANA VIRANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date: 10/30/2018
Reactivation Date: 11/15/2018

III. Provider practice location address

303 PARKWAY DRIVE NE
ATLANTA GA
30312
US

IV. Provider business mailing address

303 PARKWAY DRIVE NE
ATLANTA GA
30312
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-6464
  • Fax: 770-968-6461
Mailing address:
  • Phone: 770-968-6464
  • Fax: 770-968-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number010667
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: