Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 057035 | GA |
N | 111NI0900X | Internist | 057035 | GA |
N | 207R00000X | Internist | 45830-020 | WI |
N | 111NI0900X | Internist | 45830-020 | WI |
Y | 207RN0300X | Nephrologist | 57035 | GA |
NPI | 1073523247 |
---|---|
Provider Name | Dr. Madhurima Adulla |
First Address | Lawrenceville, GA 30046-8709 |
Second Address | Lawrenceville, GA 30046-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H90857 | (02) |