Individual
DR. SUDHIR PREM SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5665 PEACHTREE DUNWOODY RD NE, SUITE 200, ATLANTA, GA 30342-1764
(404) 252-6104
(404) 847-9683
Mailing address
P.O. BOX 70547, MARIETTA, GA 30007
(770) 579-1894
(770) 579-1899
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
F3628
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
062083
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060059517
RAILROAD MEDICARE
TX
05
—
123718204
—
TX
Enumeration date
10/27/2005
Last updated
12/29/2010
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