Provider Demographics
NPI:1508031048
Name:MUTHUKUMAR, SRIDEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIDEVI
Middle Name:
Last Name:MUTHUKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10710 MEDLOCK BRIDGE RD
Mailing Address - Street 2:250
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1827
Mailing Address - Country:US
Mailing Address - Phone:770-870-1085
Mailing Address - Fax:770-870-1086
Practice Address - Street 1:10710 MEDLOCK BRIDGE RD
Practice Address - Street 2:250
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1827
Practice Address - Country:US
Practice Address - Phone:770-870-1085
Practice Address - Fax:770-870-1086
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2013-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA63377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics