Healthcare Provider Details

I. General information

NPI: 1649545906
Provider Name (Legal Business Name): NEIL SANJIWAN TARABADKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD STE 3100
CUMMING GA
30041
US

IV. Provider business mailing address

2001 PEACHTREE RD NE STE 705
ATLANTA GA
30309-1476
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-7777
  • Fax: 855-283-8851
Mailing address:
  • Phone: 404-355-0743
  • Fax: 404-355-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number080405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: