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General NPI Number Information
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NPI Number | 1841549227
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Entity Type | Individual
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Provider Name | PRASHANTH THALANAYAR MUTHUKRISHNAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 6095 PROFESSIONAL PKWY STE A200
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5606
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Country | US
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Telephone | 770-422-1372
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Fax | 770-999-2611
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Provider Business Mailing Address
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Address Line | 6095 PROFESSIONAL PKWY STE A200
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5606
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Country | US
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Telephone | 770-422-1372
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Fax | 770-999-2611
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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 | 293615-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 29698
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License Number State | WV
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