Provider Demographics
NPI:1104180587
Name:YARLAGADDA, KRISHNA SOWJANYA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA SOWJANYA
Middle Name:
Last Name:YARLAGADDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1285 SIMS ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3851
Practice Address - Country:US
Practice Address - Phone:770-219-8583
Practice Address - Fax:770-219-8584
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93150207R00000X
CT53611207R00000X
IAMD-45028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine