Healthcare Provider Details

I. General information

NPI: 1740117803
Provider Name (Legal Business Name): DR. SAHAN D VANGALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

522 HARGROVE LN
DECATUR GA
30030-2387
US

V. Phone/Fax

Practice location:
  • Phone: 478-973-4390
  • Fax:
Mailing address:
  • Phone: 478-960-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: