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General NPI Number Information
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NPI Number | 1750338968
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Entity Type | Individual
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Provider Name | SRINIVAS R BRAMHADEVI MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 10/03/2019
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Provider Practice Location Address
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Address Line | 1497 LAFAYETTE STREET
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City | LAGRANGE
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State | GA
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Zip | 30241-2552
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Country | US
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Telephone | 706-880-7335
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Fax | 706-812-2403
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Provider Business Mailing Address
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Address Line | 1497 LAFAYETTE STREET
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City | LAGRANGE
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State | GA
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Zip | 30241-2552
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Country | US
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Telephone | 68-807-3357
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Fax | 706-812-2403
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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 | 45129
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License Number State | WI
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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 | 61946
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License Number State | GA
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