Healthcare Provider Details

I. General information

NPI: 1033895099
Provider Name (Legal Business Name): AMRITA JARIWALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST. BI 2144
AUGUSTA GA
30912
US

IV. Provider business mailing address

600 GRAND OAKS WAY APARTMENT NUMBER 722
MARTINEZ GA
30907
US

V. Phone/Fax

Practice location:
  • Phone: 678-510-3622
  • Fax:
Mailing address:
  • Phone: 678-510-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number15132
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: