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Individual

GAUTHAM VISWANATHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
35 COLLIER RD NW, STE 610, ATLANTA, GA 30309-1613
(404) 355-7375
(404) 350-9781
Mailing address
35 COLLIER RD NW, STE 610, ATLANTA, GA 30309-1613
(404) 355-7375
(404) 350-9781

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01059360A
IN
207RN0300X
Nephrology Physician
Primary
71645
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01059360A
MEDICAL LICENSE
IN
01
71645
MEDICAL LICENSE
GA
Enumeration date
01/29/2007
Last updated
10/29/2014
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