MEDICARE: DR. VIVEKANANDA PATTABIRAMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	29763	AL
2	207R00000X	Internal Medicine Physician	45291	TN
3	207R00000X	Internal Medicine Physician	04-34597	KS
4	390200000X	Student in an Organized Health Care Education/Training Program
5	207R00000X	Internal Medicine Physician	065602	GA

General Provider Information

NPI Number	:	1467649830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVEKANANDA PATTABIRAMAN MD

Provider Business Mailing Address
First Line	:	2779 STONE HALL DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5061
Country	:	US
Telephone Number	:	862-485-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1611
Country	:	US
Telephone Number	:	404-303-3760
Fax Number	:	404-303-3759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	11/14/2023

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