Healthcare Provider Details

I. General information

NPI: 1215890017
Provider Name (Legal Business Name): SHRUTHI RAMACHANDRAN MD, LMCC, DA ,DNB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

301 BANDERA CT
SOUTHLAKE TX
76092-6039
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4544
  • Fax:
Mailing address:
  • Phone: 437-341-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0PENDING
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: