Provider Demographics
NPI:1336582733
Name:KASI, SUPRIYA HATTANGADI (MD)
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:HATTANGADI
Last Name:KASI
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 1:2244 HENDERSON MILL RD NE STE 108
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2740
Mailing Address - Country:US
Mailing Address - Phone:770-239-2500
Mailing Address - Fax:404-745-8202
Practice Address - Street 1:2244 HENDERSON MILL RD NE STE 108
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2740
Practice Address - Country:US
Practice Address - Phone:770-239-2500
Practice Address - Fax:404-745-8202
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78008208000000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program