Basic Information
| Provider Information | |||||||||
| NPI: | 1609010800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VINJAMARAM | ||||||||
| FirstName: | SANJAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FERRY RD STE 510 | ||||||||
| Address2: | |||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044191165 | ||||||||
| FaxNumber: | 4044191179 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE BLVD STE 4600 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702055292 | ||||||||
| FaxNumber: | 7702055291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2009 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 84344 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.