Pendem, Shanthan
Pendem, Shanthan is an individual health care provider with primary practice located at 1400 River Pl , Braselton GA 30517-5600. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Critical Care Medicine. Allopathic & Osteopathic Physicians / Critical Care Medicine is his primary health care specialty. Pendem, Shanthan can be contacted via phone (770) 848-8000.Contact Information
Primary practice address
1400 River Pl
Braselton GA 30517-5600
Phone: (770) 848-8000
Fax: (770) 848-8601
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 9882 | North Dakota |
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 68271 | Georgia |
Profile Details
| NPI number | 1659425817 |
|---|---|
| LBN Legal business name | Pendem, Shanthan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2007 |
| Last updated | Oct 13th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659425817 | NPPES |
| North Dakota | Other | P00256319 | RR MEDICARE |
| North Dakota | MEDICAID | 13617 | RR MEDICARE |
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