Healthcare Provider Details

I. General information

NPI: 1275705188
Provider Name (Legal Business Name): ATANU BISWAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 CAMPBELL HILL ST NW
MARIETTA GA
30060-1144
US

IV. Provider business mailing address

823 CAMPBELL HILL ST NW
MARIETTA GA
30060-1144
US

V. Phone/Fax

Practice location:
  • Phone: 770-425-0118
  • Fax:
Mailing address:
  • Phone: 770-425-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number46446
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number95101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: