Healthcare Provider Details

I. General information

NPI: 1265182802
Provider Name (Legal Business Name): SIVANIARAVINDAPRIYA NATTAMA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11459 JOHNS CREEK PKWY
JOHNS CREEK GA
30097-3515
US

IV. Provider business mailing address

11459 JOHNS CREEK PKWY
JOHNS CREEK GA
30097-3515
US

V. Phone/Fax

Practice location:
  • Phone: 770-341-5553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number113394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: