Individual
SREELATHA DIVITI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
417 W 3RD AVE, ALBANY, GA 31701-1943
(229) 312-1000
Mailing address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3834
(203) 384-3833
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
82586
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/05/2014
Last updated
09/17/2019
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