MEDICARE: DR. MEENA VISVANATHAN 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	054044	GA

General Provider Information

NPI Number	:	1720024631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEENA VISVANATHAN MD

Provider Business Mailing Address
First Line	:	759 FOX HOLLOW PKWY
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2406
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:	404-417-1770

Provider Business Practice Location Address
First Line	:	582 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-2616
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:	404-417-1770

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/08/2007

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