Individual
DR. ANITA KANITHAHALLI SHETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
835 COGBURN AVE NW, SUITE 100, MARIETTA, GA 30060-1031
(770) 422-5557
(770) 422-5456
Mailing address
5730 GLENRIDGE DR STE T100, ATLANTA, GA 30328-5747
(404) 939-9220
(470) 312-2157
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
068558
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068558
GEORGIA STATE MEDICAL LICENSE
GA
Enumeration date
06/28/2007
Last updated
01/30/2018
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