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General NPI Number Information
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NPI Number | 1023247731
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Entity Type | Individual
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Provider Name | SREEVALLI DEGA MD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 1570 BRAMPTON AVE
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City | STATESBORO
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State | GA
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Zip | 30458-0855
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Country | US
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Telephone | 912-764-9196
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Fax |
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Provider Business Mailing Address
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Address Line | 1176 BRAMPTON AVE
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City | STATESBORO
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State | GA
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Zip | 30458-0847
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Country | US
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Telephone | 912-259-9474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 39798
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 71063
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License Number State | GA
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