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General NPI Number Information
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NPI Number | 1487894069
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Entity Type | Individual
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Provider Name | ANIT S VETTUKATTIL MD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 4450 CALIBRE XING NW STE 1110
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City | ACWORTH
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State | GA
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Zip | 30101-4104
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Country | US
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Telephone | 770-924-9656
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Fax | 770-966-7288
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Provider Business Mailing Address
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Address Line | 4450 CALIBRE XING NW STE 1110
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City | ACWORTH
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State | GA
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Zip | 30101-4104
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Country | US
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Telephone | 770-924-9656
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Fax | 770-966-7288
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD13956
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 36215
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 93796
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License Number State | GA
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