Healthcare Provider Details

I. General information

NPI: 1164530051
Provider Name (Legal Business Name): DR. VOSUDESH K PAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 PROFESSIONAL DR SUITE # 350
LAWRENCEVILLE GA
30046-3367
US

IV. Provider business mailing address

631 PROFESSIONAL DR SUITE # 350
LAWRENCEVILLE GA
30046-3367
US

V. Phone/Fax

Practice location:
  • Phone: 770-995-0630
  • Fax: 678-942-5980
Mailing address:
  • Phone: 770-995-0630
  • Fax: 678-942-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number65983
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number065983
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number65983
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: