Healthcare Provider Details

I. General information

NPI: 1043267628
Provider Name (Legal Business Name): GURINDERJIT KAUR SIDHU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 EAGLES LANDING PKWY STE 302
STOCKBRIDGE GA
30281-9250
US

IV. Provider business mailing address

1100 JOHNSON FERRY RD NE SUITE 510
SANDY SPRINGS GA
30342-1709
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-0070
  • Fax: 770-507-7463
Mailing address:
  • Phone: 404-419-1140
  • Fax: 404-419-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number035275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: