Provider Demographics
NPI:1174888267
Name:RAYUDU, PARVATHI (MD)
Entity type:Individual
Prefix:
First Name:PARVATHI
Middle Name:
Last Name:RAYUDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-475-0123
Mailing Address - Fax:770-442-9526
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-475-0123
Practice Address - Fax:770-442-9526
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA76433207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174888267OtherNPI
GA202I187558Medicare UPIN