Organization
DR SIRUVELLA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRIDEVI SIRUVELLA MD (MEDICAL DIRECTOR/PHYSICIAN)
(770) 266-0567
Entity
Organization
Contact information
Practice address
705 BREEDLOVE DR, SUITE 800, MONROE, GA 30655-2090
(770) 266-0567
Mailing address
705 BREEDLOVE DR, SUITE 800, MONROE, GA 30655-2090
(770) 266-0567
(770) 266-0507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
057019
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057019
STATE MEDICAL LICENSE
GA
Enumeration date
09/09/2010
Last updated
09/10/2010
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