Healthcare Provider Details

I. General information

NPI: 1669075941
Provider Name (Legal Business Name): RESHMA HEGDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 CASTLEBERRY RD
CUMMING GA
30040-8054
US

IV. Provider business mailing address

5330 BENTLEY CREEK WAY
CUMMING GA
30040-8747
US

V. Phone/Fax

Practice location:
  • Phone: 770-887-7720
  • Fax:
Mailing address:
  • Phone: 678-237-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH024445
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: