Individual
JAYASHREE VENKATESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1435 BROADMOOR BLVD, KAISER PERMANENTE SUGAR HILL-BUFORD MEDICAL CENTER, SUGAR HILL, GA 30518
(678) 765-5700
(540) 636-8920
Mailing address
3495 PIEDMONT ROAD, NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305
(404) 504-5678
(540) 636-8920
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101237911
VA
207Q00000X
Family Medicine Physician
Primary
065912
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010147735
—
VA
01
—
P00670504
MEDICARE RR
VA
Enumeration date
02/17/2006
Last updated
03/07/2022
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