Individual
MRS. MADHURI P BASAVARAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3650 STEVE REYNOLDS BOULEVARD, KAISER PERMANENTE GWINNETT MEDICAL OFFICE, DULUTH, GA 30096
(770) 931-6010
Mailing address
3495 PIEDMONT ROAD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305
(404) 364-7070
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
002102
GA
208000000X
Pediatrics Physician
Primary
062947
GA
Other
Enumeration date
01/30/2008
Last updated
01/28/2010
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