Individual
PRAVEEN SIVAKUMARAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
631 PROFESSIONAL DR STE 450, LAWRENCEVILLE, GA 30046-3370
(770) 963-8030
(770) 339-9577
Mailing address
1700 TREE LN STE 490, SNELLVILLE, GA 30078-6756
(770) 979-2828
(770) 979-3139
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
073655
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003159182B
—
GA
01
—
2021831397
PTAN
GA
Enumeration date
05/21/2007
Last updated
03/10/2021
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