Provider Demographics
NPI:1235309469
Name:MALLAVARAPU, JAYASRI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAYASRI
Middle Name:
Last Name:MALLAVARAPU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:1614 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6883
Mailing Address - Country:US
Mailing Address - Phone:678-455-2295
Mailing Address - Fax:678-455-2279
Practice Address - Street 1:1614 PEACHTREE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6883
Practice Address - Country:US
Practice Address - Phone:678-455-2295
Practice Address - Fax:678-455-2279
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA061288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235309469OtherNPI
GA157049240CMedicaid
1235309469OtherNPI