Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301101220 | MI |
N | 111NI0900X | Internist | 4301101220 | MI |
Y | 207RI0200X | Infectious Disease | 78139 | GA |
NPI | 1063655447 |
---|---|
Provider Name | Varun Phadke |
First Address | Atlanta, GA 30308-2983 |
Second Address | Atlanta, GA 30308-2212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2009 |
Last Update Date | 26/07/2017 |