Healthcare Provider Details

I. General information

NPI: 1427861194
Provider Name (Legal Business Name): NEENA EDUPUGANTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 HEMBREE RD STE 250
ROSWELL GA
30076-5724
US

IV. Provider business mailing address

1357 HEMBREE RD STE 250
ROSWELL GA
30076-5724
US

V. Phone/Fax

Practice location:
  • Phone: 770-754-0787
  • Fax:
Mailing address:
  • Phone: 770-754-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: