Most Relevant Information
Provider Data
| NPI Number: | 1003235417 |
| Provider Name: | RENEETA BASU D.O. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | OT015694 |
Most Important Dates
| Enumeration Date: | 04/14/2014 |
| Last Updated: | 03/15/2020 |
Provider Practice Location
615 BEAVER RUIN RD NW
LILBURN
GA
300473401
Practice Location Phone/Fax
| Phone: | 7709358616 |
| Fax: |
Provider Mailing Location
1365 CLIFTON RD NE
ATLANTA
GA
303221013
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |