Healthcare Provider Details

I. General information

NPI: 1083012496
Provider Name (Legal Business Name): SINDHURA SURYADEVARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PHARR RD NE STE 605
ATLANTA GA
30305-3469
US

IV. Provider business mailing address

550 PHARR RD NE STE 605
ATLANTA GA
30305-3469
US

V. Phone/Fax

Practice location:
  • Phone: 404-235-5982
  • Fax:
Mailing address:
  • Phone: 404-235-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82788
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: