MEDICARE: SATEESH RAMKISHAN DEVAGUPTHAPU 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	2083P0901X	Public Health & General Preventive Medicine Physician	9090A	WY
2	208600000X	Surgery Physician	9090A	WY
3	2083X0100X	Occupational Medicine Physician	074823	GA

General Provider Information

NPI Number	:	1316263593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATEESH RAMKISHAN DEVAGUPTHAPU MD

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	3931 MUNDY MILL RD STE C
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3431
Country	:	US
Telephone Number	:	770-219-8275
Fax Number	:

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

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	05/04/2022

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