Provider Demographics
NPI:1235133869
Name:CHERVU, INDIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:
Last Name:CHERVU
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 1:55 WHITCHER ST NE
Mailing Address - Street 2:STE 460
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1171
Mailing Address - Country:US
Mailing Address - Phone:770-427-7389
Mailing Address - Fax:770-427-2845
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:STE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1171
Practice Address - Country:US
Practice Address - Phone:770-427-7389
Practice Address - Fax:770-427-2845
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA040032207RN0300X
GA040032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000665706DMedicaid
GA000665706GMedicaid
GA000665706HMedicaid
GA000665706IMedicaid
GA000665706BMedicaid
GA000665706JMedicaid
GA000665706LMedicaid
GA000665706TMedicaid
GA000665706EMedicaid
GA000665706QMedicaid
GA00665706AMedicaid
GA000665706RMedicaid
GA000665706CMedicaid
GA000665706KMedicaid
GA000665706OMedicaid
GA000665706NMedicaid
GA000665706IMedicaid
GA000665706NMedicaid