Healthcare Provider Details

I. General information

NPI: 1780070235
Provider Name (Legal Business Name): SESANK SAI MIKKILINENI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PROFESSIONAL DR STE A220
LAWRENCEVILLE GA
30046-7698
US

IV. Provider business mailing address

3000 TULANE AVE APT 425
NEW ORLEANS LA
70119-7292
US

V. Phone/Fax

Practice location:
  • Phone: 470-325-1160
  • Fax: 678-701-9860
Mailing address:
  • Phone: 973-722-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number85386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: