Healthcare Provider Details

I. General information

NPI: 1972099463
Provider Name (Legal Business Name): SEETHA LAKSHMANAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LOWER FAYETTEVILLE RD STE B
NEWNAN GA
30265-1133
US

IV. Provider business mailing address

1200 LOWER FAYETTEVILLE RD STE B
NEWNAN GA
30265-1133
US

V. Phone/Fax

Practice location:
  • Phone: 678-631-4610
  • Fax: 678-631-4611
Mailing address:
  • Phone: 678-631-4610
  • Fax: 678-631-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101487
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: