Healthcare Provider Details

I. General information

NPI: 1336370451
Provider Name (Legal Business Name): MAMATHA PINNINTI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREENFIELD DR STE 260
CUMMING GA
30040-2727
US

IV. Provider business mailing address

3970 DEP BILL CANTRELL MEMORIAL RD
CUMMING GA
30040-3011
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax: 678-513-8869
Mailing address:
  • Phone: 678-513-2273
  • Fax: 678-513-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number94918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: