Provider Demographics
NPI:1588655997
Name:GIRIJA, VALLIKKAT T (MD)
Entity Type:Individual
Prefix:DR
First Name:VALLIKKAT
Middle Name:T
Last Name:GIRIJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2489
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-8925
Mailing Address - Country:US
Mailing Address - Phone:770-507-4414
Mailing Address - Fax:770-507-4415
Practice Address - Street 1:1500 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-8925
Practice Address - Country:US
Practice Address - Phone:770-507-4414
Practice Address - Fax:770-507-4415
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022932207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000614193BMedicaid
GA000614193BMedicaid
11BDKTSMedicare ID - Type Unspecified