MEDICARE: ANJU ANNA OOMMEN M.D.

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	003446	GA
2	207RN0300X	Nephrology Physician	066386	GA

General Provider Information

NPI Number	:	1861657835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJU ANNA OOMMEN M.D.

Provider Business Mailing Address
First Line	:	7107 RENAISSANCE WAY NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2474
Country	:	US
Telephone Number	:	404-704-5488
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 WESTVIEW DRIVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1495
Country	:	US
Telephone Number	:	404-752-1857
Fax Number	:	404-752-1088

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

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	09/25/2015

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