Provider Demographics
NPI:1730335407
Name:RADHAKRISHNAN, JAYDEEP KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAYDEEP
Middle Name:KUMAR
Last Name:RADHAKRISHNAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:1435 BROADMOOR BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA66050207Q00000X
OH57-014665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine