MEDICARE: MARIYA GEORGE CHERIYAMPURATHU

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	363LF0000X	Family Nurse Practitioner	NP285695	GA

General Provider Information

NPI Number	:	1649125808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIYA GEORGE CHERIYAMPURATHU

Provider Business Mailing Address
First Line	:	2846 MALTON WAY
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-1112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 MARKET ST
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-1246
Country	:	US
Telephone Number	:	770-341-4092
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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