Provider Demographics
NPI:1437137015
Name:SRINIVASIAH, JAYANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:
Last Name:SRINIVASIAH
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 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-496-5555
Mailing Address - Fax:770-939-2887
Practice Address - Street 1:2712 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2512
Practice Address - Country:US
Practice Address - Phone:770-496-5555
Practice Address - Fax:770-939-2887
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033204207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000543606ANMedicaid
GA000543606AMMedicaid
GA000543606ACMedicaid
GA202I832082Medicare PIN