Provider Demographics
NPI:1154443091
Name:SUBBANNAN, KARTHI (MD)
Entity type:Individual
Prefix:DR
First Name:KARTHI
Middle Name:
Last Name:SUBBANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-623-8965
Mailing Address - Fax:770-623-4018
Practice Address - Street 1:6300 HOSPITAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1982
Practice Address - Country:US
Practice Address - Phone:770-623-8965
Practice Address - Fax:770-623-4018
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062169207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA738700884CMedicaid
GA738700884DMedicaid
GA738700884DMedicaid