| Dr Siruvella Md Pc | |
|
705 Breedlove Dr Suite 800 Monroe GA 30655-2090 | |
| (770) 266-0567 | |
| Not Available |
| Full Name | Dr Siruvella Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 705 Breedlove Dr, Monroe, Georgia |
| Authorized Official Name and Position | Sridevi Siruvella (MEDICAL DIRECTOR/PHYSICIAN) |
| Authorized Official Contact | 7702660567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Siruvella Md Pc 705 Breedlove Dr Suite 800 Monroe GA 30655-2090 Ph: (770) 266-0567 | Dr Siruvella Md Pc 705 Breedlove Dr Suite 800 Monroe GA 30655-2090 Ph: (770) 266-0567 |
| NPI Number | 1447567631 |
|---|---|
| Provider Enumeration Date | 09/09/2010 |
| Last Update Date | 09/10/2010 |
| Medicare PECOS PAC ID | 1557557238 |
|---|---|
| Medicare Enrollment ID | O20101119000777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447567631 | NPI | - | NPPES |
| 057019 | Other | GA | STATE MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 057019 (Georgia) | Primary |
| Provider Name | Sridevi Siruvella |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164483871 PECOS PAC ID: 2365405933 Enrollment ID: I20061013000223 |
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