Individual
DR. VIDYA SOUNDARARAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1791 MULKEY RD, SUITE 200, AUSTELL, GA 30106-1124
(770) 732-5400
(770) 944-0327
Mailing address
1791 MULKEY RD, SUITE 200, AUSTELL, GA 30106-1124
(770) 732-5400
(770) 944-0327
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
047949
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00844841A
—
GA
01
—
58-1397572
FEDERAL TAX ID#
GA
Enumeration date
09/09/2005
Last updated
12/16/2019
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