Provider Demographics
NPI:1346344405
Name:MEDURI, NAGA BHAVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGA
Middle Name:BHAVANI
Last Name:MEDURI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:972-860-8679
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DRIVE, SUITE 350
Practice Address - Street 2:KAISER PERMANENTE FORSYTH MEDICAL CENTER
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:214-265-1818
Practice Address - Fax:214-265-1806
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXM4876207N00000X
GA057104207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program