Healthcare Provider Details

I. General information

NPI: 1962528257
Provider Name (Legal Business Name): PAVNA MADHAVI BRAHMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAVNA MADHAVI KARTHA M.D.

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK ROAD SUITE 270
ATLANTA GA
30342
US

IV. Provider business mailing address

9600 BLACKWELL ROAD SUITE 500
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-2229
  • Fax: 404-257-0792
Mailing address:
  • Phone: 301-340-1188
  • Fax: 404-257-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number59607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: