Basic Information
| Provider Information | |||||||||
| NPI: | 1659895373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JALA | ||||||||
| FirstName: | SUDHISHA | ||||||||
| MiddleName: | KUMARI | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 PEACHTREE ST NE | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303093276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709891623 | ||||||||
| FaxNumber: | 6783881759 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 JOHNSON FERRY RD STE 820 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042529307 | ||||||||
| FaxNumber: | 4042525839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 008523 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.