Individual
OSARA DHEVMI MALALASEKARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
708 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-5402
Mailing address
708 S 8TH ST, GRIFFIN, GA 30224-4827
(770) 228-5402
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
91010
GA
Other
Enumeration date
04/24/2019
Last updated
08/23/2022
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