Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 87471 | GA |
NPI | 1023403144 |
---|---|
Provider Name | Srividya Srinivasamaharaj |
First Address | Atlanta, GA 30368-7339 |
Second Address | Columbus, GA 31904-8915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 12/10/2021 |