Healthcare Provider Details

I. General information

NPI: 1235133869
Provider Name (Legal Business Name): INDIRA CHERVU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE STE 460
MARIETTA GA
30060-1171
US

IV. Provider business mailing address

55 WHITCHER ST NE STE 460
MARIETTA GA
30060-1171
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-7389
  • Fax: 770-427-2845
Mailing address:
  • Phone: 770-427-7389
  • Fax: 770-427-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberGA040032
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number040032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: