Healthcare Provider Details

I. General information

NPI: 1205761251
Provider Name (Legal Business Name): HARSHITA LACHHWANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 UPPER RIVERDALE RD. RIVERDALE GA 30274 SITE 210
RIVERDALE GA
30274
US

IV. Provider business mailing address

SOUTHERN REGIONAL MEDICAL CENTER 11 UPPER RIVERDALE ROLE, SW,
RIVERDALE GA
30274
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-8570
  • Fax:
Mailing address:
  • Phone: 770-991-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: