1053344051 NPI number — DR. HYMAVATI MIKKILINENI M.D.

Table of content: DR. HYMAVATI MIKKILINENI M.D. (NPI 1053344051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053344051 NPI number — DR. HYMAVATI MIKKILINENI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIKKILINENI
Provider First Name:
HYMAVATI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053344051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
483 UPPER RIVERDALE RD SW
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30274-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-994-0242
Provider Business Mailing Address Fax Number:
770-994-4386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 UPPER RIVERDALE RD SW
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30274-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-994-0242
Provider Business Practice Location Address Fax Number:
770-994-4386
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  028440 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00329304A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 581692055 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com