Basic Information
Provider Information | |||||||||
NPI: | 1952503344 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VARUGHESE | ||||||||
FirstName: | SMITHA | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FRANCIS | ||||||||
OtherFirstName: | NEELAMKAVIL | ||||||||
OtherMiddleName: | SMITHA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1000 MEDICAL CENTER BLVD | ||||||||
Address2: |   | ||||||||
City: | LAWRENCEVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 300467694 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6783123294 | ||||||||
FaxNumber: | 6783123282 | ||||||||
Practice Location | |||||||||
Address1: | 1000 MEDICAL CENTER BLVD | ||||||||
Address2: |   | ||||||||
City: | LAWRENCEVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 300467694 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6783123294 | ||||||||
FaxNumber: | 6783123282 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/05/2007 | ||||||||
LastUpdateDate: | 07/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD60076622 | WA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 57011140 | OH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | MD60076622 | WA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208M00000X | 80723 | GA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.