Healthcare Provider Details

I. General information

NPI: 1982915633
Provider Name (Legal Business Name): SWATI PULLAMARAJU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400C OLD MILTON PKWY STE 270
ALPHARETTA GA
30005-4438
US

IV. Provider business mailing address

3400C OLD MILTON PKWY STE 270
ALPHARETTA GA
30005-4438
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1911
  • Fax: 770-663-8905
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-663-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45976
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: