Provider Demographics
NPI:1245607530
Name:JAYVELIYATHMDINC
Entity Type:Organization
Organization Name:JAYVELIYATHMDINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYASHREE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VELIYATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-971-0633
Mailing Address - Street 1:2155 POST OAK TRITT RD
Mailing Address - Street 2:STE580
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8620
Mailing Address - Country:US
Mailing Address - Phone:770-971-0633
Mailing Address - Fax:770-971-3182
Practice Address - Street 1:2155 POST OAK TRITT RD
Practice Address - Street 2:STE580
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8620
Practice Address - Country:US
Practice Address - Phone:770-971-0633
Practice Address - Fax:770-971-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38638261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE68240Medicare UPIN