Provider Demographics
NPI:1174613459
Name:INFECTIOUS DISEASE PROFESSIONALS, LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULAMADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-617-9649
Mailing Address - Street 1:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30023-3988
Mailing Address - Country:US
Mailing Address - Phone:678-542-3499
Mailing Address - Fax:678-252-9679
Practice Address - Street 1:101 GREENFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2727
Practice Address - Country:US
Practice Address - Phone:678-845-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50861207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6415Medicare ID - Type Unspecified
GAI05167Medicare UPIN