Healthcare Provider Details

I. General information

NPI: 1538132733
Provider Name (Legal Business Name): HARISCHANDRA PIYASENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DR SUITE 502
AUSTELL GA
30106-6810
US

IV. Provider business mailing address

1700 HOSPITAL SOUTH DR SUITE 502
AUSTELL GA
30106
US

V. Phone/Fax

Practice location:
  • Phone: 770-739-9555
  • Fax: 770-732-8110
Mailing address:
  • Phone: 678-741-2317
  • Fax: 678-741-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number017078
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number017078
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: