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General NPI Number Information
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NPI Number | 1174613459
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASE PROFESSIONALS, LLC
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 101 GREENFIELD DR STE 100
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City | CUMMING
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State | GA
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Zip | 30040-2727
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Country | US
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Telephone | 678-845-7300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | ALPHARETTA
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State | GA
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Zip | 30023-3988
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Country | US
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Telephone | 678-542-3499
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Fax | 678-252-9679
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SURESH VEMULAMADA
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Credential |
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Telephone | 352-617-9649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 50861
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License Number State | GA
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