Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 076655 | GA |
N | 207RP1001X | Pulmonary Disease | 076655 | GA |
NPI | 1073704581 |
---|---|
Provider Name | Dr. Arvind Jayaraj Ponnambalam |
First Address | Fayetteville, GA 30214-4526 |
Second Address | Fayetteville, GA 30214-4526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 28/09/2016 |