Provider Demographics
NPI:1346645124
Name:PERSAUD, USHVANI HD
Entity Type:Individual
Prefix:
First Name:USHVANI
Middle Name:HD
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N ARCADIA AVE
Mailing Address - Street 2:EVP CLINIC
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2115
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:
Practice Address - Street 1:250 N ARCADIA AVE
Practice Address - Street 2:EVP CLINIC
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2115
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0801541041C0700X
NJ44SC055202001041C0700X
NMC-073891041C0700X
GACSW0054981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1346645124OtherNPI
NY1346645124OtherNPI
NJ1346645124OtherNPI
NM1346645124OtherNPI