MEDICARE: DR. MADHAVI DEVARAJU 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	207Q00000X	Family Medicine Physician	058737	GA

General Provider Information

NPI Number	:	1699969949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADHAVI DEVARAJU M.D.

Provider Business Mailing Address
First Line	:	2700 ABBEY CT
Second Line	:	THE OFFICES @ CRABAPPLE VILLAGE
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-6024
Country	:	US
Telephone Number	:	770-772-4233
Fax Number	:	770-772-4872

Provider Business Practice Location Address
First Line	:	2700 ABBEY CT
Second Line	:	THE OFFICES @ CRABAPPLE VILLAGE
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-6024
Country	:	US
Telephone Number	:	770-772-4233
Fax Number	:	770-772-4872

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	07/23/2013

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