Individual
DR. MAMATHA GAVINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
20 GLENLAKE PKWY, KAISER PERMANENTE GLENLAKE MEDICAL OFFICE, ATLANTA, GA 30328-3473
(770) 677-6037
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 364-7070
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
054888
GA
208000000X
Pediatrics Physician
Primary
054888
GA
Other
Enumeration date
02/23/2007
Last updated
01/07/2022
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