Individual
JAYA M. THERATTIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3630 J DEWEY GRAY CIR, AUGUSTA, GA 30909-1867
(706) 855-6130
(706) 855-6139
Mailing address
3630 J DEWEY GRAY CIR, AUGUSTA, GA 30909-1867
(706) 855-6130
(706) 855-6139
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
048731
GA
2080P0201X
Pediatric Allergy/Immunology Physician
048731
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000893802B
—
GA
05
—
000893802C
—
GA
05
—
000893802D
—
GA
05
—
G48731
—
SC
Enumeration date
02/22/2006
Last updated
07/14/2021
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