MEDICARE: DR. PAYASWINI VASANTH M.D.

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	207RN0300X	Nephrology Physician	75557	GA
2	207R00000X	Internal Medicine Physician	BPI-0036671	TX

General Provider Information

NPI Number	:	1639494230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAYASWINI VASANTH M.D.

Provider Business Mailing Address
First Line	:	117 HILLYER PL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1909
Country	:	US
Telephone Number	:	703-577-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE BLDG B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	855-366-7989
Fax Number	:

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

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	01/12/2026

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