Provider Demographics
NPI:1548552011
Name:BHASKARAN, MUTHU DEEPAK VIGNESH (MD)
Entity type:Individual
Prefix:DR
First Name:MUTHU
Middle Name:DEEPAK VIGNESH
Last Name:BHASKARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD, NE ST415
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 BOULEVARD NE STE 415
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4210
Practice Address - Country:US
Practice Address - Phone:404-265-4400
Practice Address - Fax:404-265-5542
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA739462084A2900X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical CareGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty