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General NPI Number Information
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NPI Number | 1336593557
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Entity Type | Individual
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Provider Name | ANEESHA ANANTHULA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 6985 MCGINNIS FERRY RD STE 100
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City | DULUTH
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State | GA
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Zip | 30097-1547
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Country | US
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Telephone | 678-726-6203
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Fax | 678-647-7955
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Provider Business Mailing Address
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Address Line | 5235 WINFLOW WAY
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City | SUWANEE
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State | GA
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Zip | 30024-5333
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 322308
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 96502
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License Number State | GA
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