Provider Demographics
NPI:1326014002
Name:SRINIVASAN, AJAI (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAI
Middle Name:
Last Name:SRINIVASAN
Suffix:
Gender:M
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:NORTH GROVE MEDICAL PARK SUITE 2300
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2244
Practice Address - Country:US
Practice Address - Phone:864-585-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19711208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG699297628OtherMEDICARE PIN
SC197110Medicaid
SCG699293365OtherMEDICARE PIN
SC197525OtherMEDCOST
SC7169404OtherAETNA
NC5911182Medicaid
SCG69929Medicare PIN