Provider Demographics
NPI:1104433382
Name:SUNDARESAN, ADITI BHATTACHARJEE (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:ADITI
Middle Name:BHATTACHARJEE
Last Name:SUNDARESAN
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 N DECATUR RD STE 295
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5936
Mailing Address - Country:US
Mailing Address - Phone:404-778-6400
Mailing Address - Fax:
Practice Address - Street 1:2801 N DECATUR RD STE 295
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5936
Practice Address - Country:US
Practice Address - Phone:404-778-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10656363A00000X
GA10525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant