Provider Demographics
NPI:1467614016
Name:RAMASUBBU, CHITRA (MD)
Entity Type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:RAMASUBBU
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 1:145 RIVERSTONE TER STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5327
Mailing Address - Country:US
Mailing Address - Phone:770-450-4807
Mailing Address - Fax:
Practice Address - Street 1:145 RIVERSTONE TER STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5327
Practice Address - Country:US
Practice Address - Phone:770-450-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067966207L00000X
GA67966207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA67966OtherMEDICAL LICENSE