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General NPI Number Information
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NPI Number | 1952393803
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Entity Type | Individual
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Provider Name | PRIYA SHIVA VISHNUBHOTLA MD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1412 MILSTEAD AVE NE STE 300
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City | CONYERS
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State | GA
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Zip | 30012-3877
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Country | US
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Telephone | 404-918-2320
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Fax |
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Provider Business Mailing Address
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Address Line | 70 W GORE ST STE 100
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City | ORLANDO
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State | FL
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Zip | 32806-1124
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Country | US
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Telephone | 407-426-8484
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Fax | 407-426-8575
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME93654
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 95261
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License Number State | GA
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