Provider Demographics
NPI:1528020575
Name:KRISHNA, JEEVANA (MD)
Entity Type:Individual
Prefix:
First Name:JEEVANA
Middle Name:
Last Name:KRISHNA
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 1:765 LANIER 400 PKWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2539
Mailing Address - Country:US
Mailing Address - Phone:770-205-1294
Mailing Address - Fax:770-205-1783
Practice Address - Street 1:765 LANIER 400 PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2539
Practice Address - Country:US
Practice Address - Phone:770-205-1294
Practice Address - Fax:770-205-1783
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000579961GMedicaid
GA000579961IMedicaid
GA000579961HMedicaid
GA000579961CMedicaid
GA000579961GMedicaid
F17013Medicare UPIN