MEDICARE: LAVANYA SUBRAMANIAN M.D.

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	036122	GA

General Provider Information

NPI Number	:	1588727952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVANYA SUBRAMANIAN M.D.

Provider Business Mailing Address
First Line	:	1620 HICKORY STREET
Second Line	:	STE 406
City	:	DALTON
State	:	GA
Zip	:	30720
Country	:	US
Telephone Number	:	706-270-5002
Fax Number	:	706-270-5111

Provider Business Practice Location Address
First Line	:	191 LAMAR HALEY PARKWAY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8019
Country	:	US
Telephone Number	:	770-704-1600
Fax Number	:	770-704-1610

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	04/15/2010

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