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General NPI Number Information
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NPI Number | 1043414196
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA DIABETES AND ENDOCRINOLOGY
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 1505 NORTHSIDE BLVD SUITE 2800
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City | CUMMING
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State | GA
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Zip | 30041
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Country | US
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Telephone | 678-749-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 11585 JONES BRIDGE RD SUITE 420-127
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City | ALPHARETTA
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State | GA
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Zip | 30022-8129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GEETHA REDDY SOODINI
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Credential | MD
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Telephone | 678-749-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 059025
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License Number State | GA
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