MEDICARE: DR. MUTHAYYAH SRINIVASAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	052836	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205835501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUTHAYYAH SRINIVASAN MD

Provider Business Mailing Address
First Line	:	5447 DIVIDEND DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-8412
Country	:	US
Telephone Number	:	770-322-8881
Fax Number	:	770-322-8886

Provider Business Practice Location Address
First Line	:	5447 DIVIDEND DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-8412
Country	:	US
Telephone Number	:	770-322-8881
Fax Number	:	770-322-8886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2015

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