Healthcare Provider Details

I. General information

NPI: 1922307610
Provider Name (Legal Business Name): SHARMIN BANU ANAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 JOHNS CREEK PKWY SUITE A
SUWANEE GA
30024-6038
US

IV. Provider business mailing address

3400 OLD MILTON PKWY STE C270
ALPHARETTA GA
30005-4414
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1911
  • Fax: 678-802-5765
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-663-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: