Healthcare Provider Details

I. General information

NPI: 1861545758
Provider Name (Legal Business Name): HEMA V SHEELVANTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEMA V ASHWIN CRN

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/02/2019
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: 770-427-1492
Mailing address:
  • Phone: 770-427-7389
  • Fax: 770-427-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209-005362
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-291744
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number83544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: