Healthcare Provider Details

I. General information

NPI: 1326274044
Provider Name (Legal Business Name): SBMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 S COBB DR SE 120
SMYRNA GA
30080-6303
US

IV. Provider business mailing address

PO BOX 15323
ATLANTA GA
30333-0323
US

V. Phone/Fax

Practice location:
  • Phone: 770-319-8013
  • Fax: 770-319-8021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number057284
License Number StateGA

VIII. Authorized Official

Name: SMITHA BHANDARI
Title or Position: CEO
Credential: MD
Phone: 404-917-3256