Healthcare Provider Details

I. General information

NPI: 1972913689
Provider Name (Legal Business Name): SANDEEP RAJ SABHLOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 HOSPITAL PKWY
JOHNS CREEK GA
30097-5775
US

IV. Provider business mailing address

1954 AIRPORT RD UNIT 916
ATLANTA GA
30341-4956
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4889
  • Fax:
Mailing address:
  • Phone: 714-366-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number295039
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number101011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: