Provider Demographics
NPI:1053300061
Name:INDERJITH, SWARNALATHA (MD)
Entity Type:Individual
Prefix:
First Name:SWARNALATHA
Middle Name:
Last Name:INDERJITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWARNALATHA
Other - Middle Name:
Other - Last Name:SUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1192
Mailing Address - Country:US
Mailing Address - Phone:770-415-0874
Mailing Address - Fax:
Practice Address - Street 1:GEORGIA HOPE.
Practice Address - Street 2:203, WOODPARK LANE, BUILDING B #200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:706-279-0405
Practice Address - Fax:706-279-4190
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0393732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76241Medicare UPIN