Provider Demographics
NPI:1417907890
Name:VARMA, VIJAY ALLURI (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:ALLURI
Last Name:VARMA
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:VA MEDICAL CENTER LAB SERVICES
Mailing Address - Street 2:1670 CLAIRMONT RD.
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-235-3010
Mailing Address - Fax:404-235-3007
Practice Address - Street 1:VA MEDICAL CENTER LAB SERVICES
Practice Address - Street 2:1670 CLAIRMONT RD.
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-235-3010
Practice Address - Fax:404-235-3007
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029547207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA029547OtherMEDICAL LICENSE