Individual
SRIDEVI VENUGOPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(770) 716-0051
Mailing address
3392 CLUBLAND DR, MARIETTA, GA 30068-2507
(404) 801-5353
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN235224
GA
363LA2100X
Acute Care Nurse Practitioner
RN235224
GA
Other
Enumeration date
12/18/2023
Last updated
01/14/2026
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