Healthcare Provider Details

I. General information

NPI: 1619976826
Provider Name (Legal Business Name): PRAVEER SRIVASTAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 BOB ARNOLD BLVD STE A
LITHIA SPRINGS GA
30122-3258
US

IV. Provider business mailing address

13000 RIVERS BEND BLVD STE D
CHESTER VA
23836-8632
US

V. Phone/Fax

Practice location:
  • Phone: 770-769-1724
  • Fax: 770-708-6599
Mailing address:
  • Phone: 804-571-5106
  • Fax: 804-530-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101231604
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0101231604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: