Healthcare Provider Details

I. General information

NPI: 1811575533
Provider Name (Legal Business Name): REVANTH SAI YENDAMURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREENFIELD DR STE 100
CUMMING GA
30040-3171
US

IV. Provider business mailing address

5655 CANNONERO DR
ALPHARETTA GA
30005-7871
US

V. Phone/Fax

Practice location:
  • Phone: 678-845-7300
  • Fax:
Mailing address:
  • Phone: 770-361-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number112150
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number112150
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: