Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 48777 | GA |
N | 207RC0000X | Internist - Cardiovascular Disease | 48777 | GA |
NPI | 1215923701 |
---|---|
Provider Name | Sreeni R. Gangasani |
First Address | Lawrenceville, GA 30046-8725 |
Second Address | Lawrenceville, GA 30046-8725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00866412E | (05) | GA |
H13625 | (02) |