Provider Demographics
NPI:1437346384
Name:SWARNALATHA INDERJITH.MD.PC
Entity Type:Organization
Organization Name:SWARNALATHA INDERJITH.MD.PC
Other - Org Name:TRICOUNTY BEHAVIORAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SWARNALATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:INDERJITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-917-1050
Mailing Address - Street 1:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1192
Mailing Address - Country:US
Mailing Address - Phone:770-917-1050
Mailing Address - Fax:770-917-0301
Practice Address - Street 1:2365 HIGHWAY 92
Practice Address - Street 2:#110
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7712
Practice Address - Country:US
Practice Address - Phone:770-917-1050
Practice Address - Fax:770-917-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)