Individual
SANJEEV S TENDOLKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4589 LAWRENCEVILLE RD, LOGANVILLE, GA 30052-7320
(770) 466-8672
(770) 466-2082
Mailing address
4589 LAWRENCEVILLE RD, LOGANVILLE, GA 30052-7320
(770) 466-8672
(770) 466-2082
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
63066
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I084637
MEDICARE PTAN
—
Enumeration date
05/23/2007
Last updated
09/24/2012
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