Healthcare Provider Details

I. General information

NPI: 1528905700
Provider Name (Legal Business Name): YASASWINI SAI POTTURI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0006
US

IV. Provider business mailing address

4345 HASTINGS DR
CUMMING GA
30041-5853
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-0211
  • Fax:
Mailing address:
  • Phone: 678-283-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number112866
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: