Individual provider Active NPI

Dheera Ananthakrishnan, MD

  • Orthopaedic Surgery of the Spine Physician
  • Atlanta, GA
National Provider Identifier
1780768192
Registry record updated Apr 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
059591 Issued in GA
Practice address
59 Executive Park South
Suite 3000
Atlanta, GA 30329
Phone
(404) 778-6306
Fax
(404) 778-6376
NPI assigned
Oct 24, 2006
Last updated
Apr 9, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD00042731 WA
Orthopaedic Surgery of the Spine Physician 207XS0117X 059591 GA Primary

Addresses

Primary practice location

59 Executive Park South
Suite 3000
Atlanta, GA 30329

Mailing address

59 Executive Park South
Suite 3000
Atlanta, GA 30329
Phone (404) 778-6306

Other identifiers 1

IdentifierTypeStateIssuer
8374316MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071023000608 GA Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 4486558954 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00042731WAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc CurrentSince Aug 1, 2007 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Aug 1, 2007 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

59 Executive Park South NE
Ste 3000
Atlanta, GA 30329
Phone (404) 778-6227

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

Interoperability endpoints

  • Direct secure messaging: dheera.ananthakrishnan.1@30093.direct.athenahealth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270771200000",
    "number": "1780768192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 EXECUTIVE PARK SOUTH",
            "address_2": "SUITE 3000",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30329",
            "telephone_number": "404-778-6306",
            "fax_number": "404-778-6376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 EXECUTIVE PARK SOUTH",
            "address_2": "SUITE 3000",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30329",
            "telephone_number": "404-778-6306",
            "fax_number": "404-778-6376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANANTHAKRISHNAN",
        "first_name": "DHEERA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2010-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD00042731",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "GA",
            "license": "059591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8374316",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.