Healthcare Provider Details

I. General information

NPI: 1376022434
Provider Name (Legal Business Name): NEENA BHATIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 BUFORD HWY STE 1
DULUTH GA
30096-5707
US

IV. Provider business mailing address

8820 FULHAM CT
CUMMING GA
30041-8042
US

V. Phone/Fax

Practice location:
  • Phone: 678-243-5021
  • Fax: 678-243-5020
Mailing address:
  • Phone: 678-200-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN230108
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN23018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: