Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 058204 | GA |
NPI | 1013927003 |
---|---|
Provider Name | Dr. Sujatha Vivek |
First Address | Suwanee, GA 30024-1048 |
Second Address | Suwanee, GA 30024-1048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 01/10/2021 |