Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 036.120757 | IL |
N | 207W00000X | Ophthalmologist | 35.096094 | OH |
Y | 207W00000X | Ophthalmologist | 71281 | GA |
NPI | 1013129725 |
---|---|
Provider Name | Kiran Sajja |
First Address | Suwanee, GA 30024-4539 |
Second Address | Suwanee, GA 30024-4539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 28/02/2017 |