Doctor Name: | THARA MRITHULA VIDYASAGARAN |
NPI Number: | 1043566201 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D |
License Number: | |
Business Practice Address: | Gme Emory School Of Medicine 1648 Pierce Dr Ne Atlanta, GA - 303220001 |
Business Phone Number: | 4047275640 |
Business Fax Number: | 4047270473 |
Mailing Address: | Gme Emory School Of Medicine 1648 Pierce Dr Ne, ATLANTA |
State: | GA |
Postal Code: | 303220001 |
Phone Number: | 4047275640 |
Fax Number: | 4047270473 |
NPI Enumeration Date: | 07/25/2012 |
NPI Last Update Date: | 07/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |