Provider Demographics
NPI:1275520090
Name:PRASAD, VIJITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJITHA
Middle Name:
Last Name:PRASAD
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 1:544 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3230
Mailing Address - Country:US
Mailing Address - Phone:478-237-2527
Mailing Address - Fax:478-237-7406
Practice Address - Street 1:544 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3230
Practice Address - Country:US
Practice Address - Phone:478-237-2527
Practice Address - Fax:478-237-7406
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA040520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00672086AMedicaid
GA00672086AMedicaid
GAG13712Medicare UPIN