Healthcare Provider Details

I. General information

NPI: 1336132158
Provider Name (Legal Business Name): ARUN CHERVU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WHITCHER ST NE STE 2100
MARIETTA GA
30060-1179
US

IV. Provider business mailing address

100 STONEFOREST DR STE 130
WOODSTOCK GA
30189-4881
US

V. Phone/Fax

Practice location:
  • Phone: 704-230-5957
  • Fax: 770-874-1614
Mailing address:
  • Phone: 770-423-0595
  • Fax: 678-388-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number039753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: