Provider Demographics
NPI:1558369413
Name:GUNAWARDHANA, HEMACHANDRA PEMASIRI (MD)
Entity Type:Individual
Prefix:
First Name:HEMACHANDRA
Middle Name:PEMASIRI
Last Name:GUNAWARDHANA
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 1:3188 ATLANTA RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8256
Mailing Address - Country:US
Mailing Address - Phone:770-319-6000
Mailing Address - Fax:770-319-6330
Practice Address - Street 1:3188 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8256
Practice Address - Country:US
Practice Address - Phone:770-319-6000
Practice Address - Fax:770-319-6330
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO340112084P0800X
GA633412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH87846Medicare UPIN