Healthcare Provider Details

I. General information

NPI: 1700260726
Provider Name (Legal Business Name): DIVYA MANASA AKELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BA9413
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST # BA9413
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 408-508-9603
  • Fax:
Mailing address:
  • Phone: 408-508-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number99448
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: