MEDICARE: JAGAN CHILAKAMARRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	055734	GA

General Provider Information

NPI Number	:	1528000197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGAN CHILAKAMARRI MD

Provider Business Mailing Address
First Line	:	PO BOX 27270
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31221-7270
Country	:	US
Telephone Number	:	478-405-5880
Fax Number	:	478-405-5992

Provider Business Practice Location Address
First Line	:	5400 LAUREL SPRINGS PKWY
Second Line	:	UNIT 602
City	:	SUWANEE
State	:	GA
Zip	:	30024-6056
Country	:	US
Telephone Number	:	770-573-9255
Fax Number	:	770-573-0505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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