Provider Demographics
NPI:1477500734
Name:ADELE, CHITURU (MD)
Entity Type:Individual
Prefix:
First Name:CHITURU
Middle Name:
Last Name:ADELE
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 1:483 UPPER RIVERDALE RD SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2584
Mailing Address - Country:US
Mailing Address - Phone:770-907-0029
Mailing Address - Fax:770-907-9183
Practice Address - Street 1:483 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE C
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2584
Practice Address - Country:US
Practice Address - Phone:770-907-0029
Practice Address - Fax:770-907-9183
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043520207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA007500318DMedicaid
GA00750318AMedicaid
GA06BDGJSMedicare PIN
GAF25699Medicare UPIN
GA007500318DMedicaid
06BDFPCMedicare ID - Type Unspecified