MEDICARE: RAMYA EMBAR SRINIVASAN

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	81404	GA

General Provider Information

NPI Number	:	1720303241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMYA EMBAR SRINIVASAN

Provider Business Mailing Address
First Line	:	2000 HOWARD FARM DR STE 400
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6084
Country	:	US
Telephone Number	:	470-747-3134
Fax Number	:	404-649-6219

Provider Business Practice Location Address
First Line	:	3400 OLD MILTON PKWY STE C500
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4408
Country	:	US
Telephone Number	:	678-775-2284
Fax Number	:	678-775-2285

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

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	12/18/2020

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