Healthcare Provider Details

I. General information

NPI: 1366645699
Provider Name (Legal Business Name): VINOD KUMAR SACHDEVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 PLUNKETT RD. DOOLY SP
UNADILLA GA
31091
US

IV. Provider business mailing address

3830 SPALDING BLUFF DR
NORCROSS GA
30092-2300
US

V. Phone/Fax

Practice location:
  • Phone: 478-627-2120
  • Fax: 478-627-9427
Mailing address:
  • Phone: 478-627-2120
  • Fax: 478-627-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number046319
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: