=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366500050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDIRA DEVU PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 10/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2520 WINDY HILL RD SE STE 306
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-955-1814
-----------------------------------------------------
Fax | 770-955-2279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2520 WINDY HILL RD SE STE 306
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-955-1814
-----------------------------------------------------
Fax | 770-955-2279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | INDIRA DEVU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 770-955-1814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 052129
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------