Organization
PEDIATRIC EPILEPSY AND CHILD (PEACH) NEUROLOGY
Active
Other names
PEACH Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOHILAVANI VELAYUDAM MD (DIRECTOR)
(847) 691-7788
Entity
Organization
Contact information
Practice address
5935 THOROUGHBRED WAY, SUWANEE, GA 30024-1744
(847) 691-7788
Mailing address
5935 THOROUGHBRED WAY, SUWANEE, GA 30024-1744
(847) 691-7788
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
72584
GA
2084N0600X
Clinical Neurophysiology Physician
72584
GA
Other
Enumeration date
01/24/2018
Last updated
03/17/2018
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