Healthcare Provider Details

I. General information

NPI: 1972330975
Provider Name (Legal Business Name): SHIVAPRIYA LAKSHMANA PERUMAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 FRANKLIN GTWY SE
MARIETTA GA
30067-8029
US

IV. Provider business mailing address

11560 GREAT OAKS WAY STE 300
ALPHARETTA GA
30022-2453
US

V. Phone/Fax

Practice location:
  • Phone: 404-474-0040
  • Fax: 404-704-0895
Mailing address:
  • Phone: 404-474-0040
  • Fax: 404-704-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2834480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: