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General NPI Number Information
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NPI Number | 1578934501
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Entity Type | Organization
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Legal Business Name | SUNSHINE PEDIATRICS OF GEORGIA,LLC
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 1485 PEACHTREE PKWY SUITE D1
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City | CUMMING
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State | GA
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Zip | 30041-0500
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Country | US
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Telephone | 470-239-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1485 PEACHTREE PKWY SUITE D1
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City | CUMMING
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State | GA
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Zip | 30041-0500
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Country | US
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Telephone | 470-239-5437
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ANANDAMADHURI VENKATA CHUNDURI
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Credential |
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Telephone | 470-239-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 064911
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License Number State | GA
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