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General NPI Number Information
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NPI Number | 1649470717
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Entity Type | Individual
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Provider Name | SUMATHI PUTTU MD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 852 DACULA RD
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City | DACULA
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State | GA
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Zip | 30019-3185
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Country | US
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Telephone | 770-848-9380
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | OAKWOOD
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State | GA
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Zip | 30566-0018
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Country | US
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Telephone | 770-219-8430
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30401
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 88494
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License Number State | GA
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