Provider Demographics
NPI:1750338968
Name:BRAMHADEVI, SRINIVAS R (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:R
Last Name:BRAMHADEVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1497 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-2552
Mailing Address - Country:US
Mailing Address - Phone:068-807-3357
Mailing Address - Fax:706-812-2403
Practice Address - Street 1:1497 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2552
Practice Address - Country:US
Practice Address - Phone:706-880-7335
Practice Address - Fax:706-812-2403
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45129207Q00000X
GA61946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA720484389AMedicaid
WI34342600Medicaid
GA720484389Medicaid
P00972282OtherRAILROAD MEDICARE
GA720484389Medicaid
WI34342600Medicaid
2020I82133Medicare PIN