Provider Demographics
NPI:1336593557
Name:ANANTHULA, ANEESHA (MD)
Entity type:Individual
Prefix:
First Name:ANEESHA
Middle Name:
Last Name:ANANTHULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANEESHA
Other - Middle Name:
Other - Last Name:MANNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5235 WINFLOW WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6985 MCGINNIS FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1547
Practice Address - Country:US
Practice Address - Phone:678-726-6203
Practice Address - Fax:678-647-7955
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322308207R00000X
GA96502207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine