Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 57.010619 | OH |
Y | 2084N0402X | Child Neurologist | 72584 | GA |
NPI | 1386819381 |
---|---|
Provider Name | Dr. Kohilavani Velayudam |
First Address | Suwanee, GA 30024-1744 |
Second Address | Duluth, GA 30097-8142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2008 |
Last Update Date | 26/01/2021 |