Provider Demographics
NPI:1982698684
Name:THOPU, ANURADHA R (MD)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:R
Last Name:THOPU
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 1:8901 STONEBRIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2210
Mailing Address - Country:US
Mailing Address - Phone:678-838-3000
Mailing Address - Fax:678-838-3155
Practice Address - Street 1:8901 STONEBRIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2210
Practice Address - Country:US
Practice Address - Phone:678-838-3000
Practice Address - Fax:678-838-3155
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041377174400000X
GA41377207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000790908EMedicaid
GA11BDVHWMedicare ID - Type UnspecifiedMEDICARE
GAG71168Medicare UPIN