Individual
DR. ANURADHA PAVULURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
777 HEMLOCK ST, MSC 10, MACON, GA 31201-2102
(478) 633-7140
(478) 633-4295
Mailing address
2490 RIVERSIDE DR, STE B, MACON, GA 31204-1787
(478) 633-6633
(478) 633-4295
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
070401
GA
208000000X
Pediatrics Physician
4301094423
MI
208000000X
Pediatrics Physician
ABO 797 603
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070401
GA LICENSE
GA
01
—
1046518
MCLAREN
MI
01
—
1046519
MCLAREN
MI
01
—
200000021987
PHP COMMERCIAL
MI
01
—
3502900092
BCBSM
MI
Enumeration date
05/24/2007
Last updated
07/13/2015
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