Individual
SREEVALLI DEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1570 BRAMPTON AVE, STATESBORO, GA 30458-0855
(912) 764-9196
Mailing address
1176 BRAMPTON AVE, STATESBORO, GA 30458-0847
(912) 259-9474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
39798
IA
207Q00000X
Family Medicine Physician
Primary
71063
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140454A
—
GA
05
—
0230169
—
IA
01
—
202I086718
PCAN
GA
Enumeration date
07/02/2009
Last updated
02/26/2021
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