Healthcare Provider Details

I. General information

NPI: 1215376801
Provider Name (Legal Business Name): NITHYA MALTI NATRAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 15TH ST
AUGUSTA GA
30901-2607
US

IV. Provider business mailing address

1535 PLATT SPRINGS RD UNIT 3915
WEST COLUMBIA SC
29171-1078
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-8878
  • Fax:
Mailing address:
  • Phone: 803-470-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78184
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD35793
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD35793
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL35793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: