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General NPI Number Information
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NPI Number | 1417804907
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Entity Type | Individual
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Provider Name | JYOTHIRMAYI MAMIDI
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Gender | Female
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 4600 ROSWELL RD UNIT C120
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City | SANDY SPRINGS
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State | GA
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Zip | 30342-3189
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Country | US
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Telephone | 404-341-9593
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Fax |
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Provider Business Mailing Address
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Address Line | 3812 MINE CREEK LN
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City | MARIETTA
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State | GA
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Zip | 30062-5884
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Country | US
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Telephone | 216-534-6237
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN124083
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License Number State | GA
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