Provider Demographics
NPI:1316428568
Name:PIDIKITI, SMITHA
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:PIDIKITI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 PIEDMONT AVE NE APT 11
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1472
Mailing Address - Country:US
Mailing Address - Phone:901-238-5196
Mailing Address - Fax:
Practice Address - Street 1:5671 PEACHTREE DUNWOODY RD STE 610
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-5013
Practice Address - Country:US
Practice Address - Phone:901-238-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367H00000X
GA9023367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant