=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205013794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUCHITA PAKKALA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2008
-----------------------------------------------------
Last Update Date | 01/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1365C CLIFTON RD NE 3RD FLOOR
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-686-1000
-----------------------------------------------------
Fax | 404-778-5520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1365C CLIFTON RD NE 3RD FLOOR
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-686-1000
-----------------------------------------------------
Fax | 404-778-5520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 059580
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------