Healthcare Provider Details

I. General information

NPI: 1376786871
Provider Name (Legal Business Name): SHAILAJA CHIDELLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HURRICANE SHOALS RD NW STE 100
LAWRENCEVILLE GA
30046-8762
US

IV. Provider business mailing address

1649 MCFARLAND BLVD N
TUSCALOOSA AL
35406-2281
US

V. Phone/Fax

Practice location:
  • Phone: 404-645-7150
  • Fax:
Mailing address:
  • Phone: 205-556-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number79107
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33362
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: