Healthcare Provider Details

I. General information

NPI: 1073608899
Provider Name (Legal Business Name): ANNAPURNA BHAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 LOST VALLEY DR
JONESBORO GA
30236-5483
US

IV. Provider business mailing address

3443 LOST VALLEY DR
JONESBORO GA
30236-5483
US

V. Phone/Fax

Practice location:
  • Phone: 404-422-3137
  • Fax:
Mailing address:
  • Phone: 404-422-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number031138
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: