Provider Demographics
NPI:1861403057
Name:VENKATESAN, MALATHI (MD)
Entity type:Individual
Prefix:DR
First Name:MALATHI
Middle Name:
Last Name:VENKATESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 SATELLITE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5256
Mailing Address - Country:US
Mailing Address - Phone:404-778-5220
Mailing Address - Fax:404-778-6451
Practice Address - Street 1:1845 SATELLITE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5256
Practice Address - Country:US
Practice Address - Phone:404-778-5220
Practice Address - Fax:404-778-6451
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMD67038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001518398OtherHIGHMARK
1536140OtherGATEWAY
1784451OtherUNITED HEALTHCARE
6709237003OtherCIGNA
3359545OtherAETNA
PA01585449Medicaid
043771728OtherHEALTH AMERICA
145688OtherUNISON
200195OtherUPMC
14517OtherELDER HEALTH
1784451OtherUNITED HEALTHCARE
G32283Medicare UPIN