Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 001831 | GA |
N | 111NI0900X | Internist | 001831 | GA |
Y | 207RN0300X | Nephrologist | 063104 | GA |
NPI | 1003096793 |
---|---|
Provider Name | Dr. Sitharam Chowdary Nandigam |
First Address | Covington, GA 30015-1157 |
Second Address | Conyers, GA 30012-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2007 |
Last Update Date | 10/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
INT0000 | (02) | GA |