=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336111558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARINI JALAGANI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 970 JOE FRANK HARRIS PKWY SE STE 280
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30120-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-607-7123
-----------------------------------------------------
Fax | 770-607-7074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 962 JOE FRANK HARRIS PKWY SE SUITE 207
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30120-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-607-7123
-----------------------------------------------------
Fax | 770-607-7074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 056103
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------