Individual
SRIDHAR VENKATA BASAVARAJU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
531 ASBURY CIR, SUITE N340, ATLANTA, GA 30322-1006
(404) 778-2624
Mailing address
5207 WESTCHESTER RDG NE, ATLANTA, GA 30329-7801
(404) 639-6341
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
060041
GA
Other
Enumeration date
09/30/2007
Last updated
09/30/2007
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