Healthcare Provider Details

I. General information

NPI: 1932358173
Provider Name (Legal Business Name): AVINASH BHAVARAJU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AVI BHAVARAJU MD, DABS, FACS, FCCM

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 CUMBERLAND PKWY SE STE 3821
ATLANTA GA
30339-6136
US

IV. Provider business mailing address

2451 CUMBERLAND PKWY SE STE 3821
ATLANTA GA
30339-6136
US

V. Phone/Fax

Practice location:
  • Phone: 404-668-2696
  • Fax:
Mailing address:
  • Phone: 404-668-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberE-10470
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberC184963
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number61043
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number61043
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberC184963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: