Provider Demographics
NPI:1528000197
Name:CHILAKAMARRI, JAGAN (MD)
Entity Type:Individual
Prefix:
First Name:JAGAN
Middle Name:
Last Name:CHILAKAMARRI
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:PO BOX 27270
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-7270
Mailing Address - Country:US
Mailing Address - Phone:478-405-5880
Mailing Address - Fax:478-405-5992
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:UNIT 602
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:770-573-9255
Practice Address - Fax:770-573-0505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0557342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH40001Medicare UPIN
GA26BDKCCMedicare ID - Type Unspecified