Healthcare Provider Details

I. General information

NPI: 1265538854
Provider Name (Legal Business Name): SATISH CUDDAPAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SANDY SPRINGS CIR NE SUITE 157A
SANDY SPRINGS GA
30328-3816
US

IV. Provider business mailing address

2559 ACACIA PARK PL
MARIETTA GA
30062-4768
US

V. Phone/Fax

Practice location:
  • Phone: 404-890-6064
  • Fax: 404-890-5587
Mailing address:
  • Phone: 770-655-0312
  • Fax: 404-890-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number048997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: