Provider Demographics
NPI:1154499481
Name:CHELLIAH, NIRMALA SOWBHAGYA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:SOWBHAGYA
Last Name:CHELLIAH
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 1:3008 INVERNESS CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6861
Mailing Address - Country:US
Mailing Address - Phone:770-760-1428
Mailing Address - Fax:
Practice Address - Street 1:EASTVIEW INTERNAL MEDICINE, P.C. 3285 SALEM ROAD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1863
Practice Address - Country:US
Practice Address - Phone:770-602-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF87070Medicare UPIN