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General NPI Number Information
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NPI Number | 1952339541
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Entity Type | Organization
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Legal Business Name | JAY VELIYATH MD INC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2790 SANDY PLAINS ROAD SUITE 202
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City | MARIETTA
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State | GA
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Zip | 30066
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Country | US
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Telephone | 770-971-0633
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Fax | 770-971-3182
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Provider Business Mailing Address
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Address Line | 2790 SANDY PLAINS ROAD SUITE 202
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City | MARIETTA
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State | GA
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Zip | 30066
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Country | US
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Telephone | 770-971-0633
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Fax | 770-971-3182
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Authorized Official
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Title or Position | CEO
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Name | DR. JAYASHREE C VELIYATH
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Credential | MD
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Telephone | 770-971-0633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K38638
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License Number State | GA
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