Healthcare Provider Details

I. General information

NPI: 1306191820
Provider Name (Legal Business Name): PRANEETHA MUSTY MBBS/MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 ATLANTA RD SE STE 315
SMYRNA GA
30080-6443
US

IV. Provider business mailing address

4441 ATLANTA RD SE STE 315
SMYRNA GA
30080-6443
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-2035
  • Fax:
Mailing address:
  • Phone: 770-333-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number308167
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number95355
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: