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General NPI Number Information
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NPI Number | 1235322033
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Entity Type | Organization
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Legal Business Name | NORTHEAST INFECTIOUS DISEASES INC
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 601 PROFESSIONAL DR # A SUITE 340
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7698
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Country | US
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Telephone | 678-376-4252
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Fax | 678-376-4253
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Provider Business Mailing Address
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Address Line | 601 PROFESSIONAL DR # A SUITE 340
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7698
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Country | US
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Telephone | 678-376-4252
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Fax | 678-376-4253
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KARUNA KUSAN
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Credential | M.D.
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Telephone | 678-376-4252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 056582
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License Number State | GA
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