Individual
GAUTHAM VISWANATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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