Healthcare Provider Details

I. General information

NPI: 1215886445
Provider Name (Legal Business Name): DR. SRIHARSHA ATHREYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WELLSTAR MCG HEALTH DEPARTMENT OF RADIOLOGY 1120 15TH STREET BA 1411
AUGUSTA GA
30912
US

IV. Provider business mailing address

4287 COUPLES CRESCENT
BURLINGTON ONTARIO
L7M4Y8
CA

V. Phone/Fax

Practice location:
  • Phone: 762-375-2209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number112992
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: