Provider Demographics
NPI:1609850650
Name:JERATH, VEENA U (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:U
Last Name:JERATH
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 1:1228 AUGUSTA WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1854
Mailing Address - Country:US
Mailing Address - Phone:706-868-8998
Mailing Address - Fax:706-868-1071
Practice Address - Street 1:1228 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1854
Practice Address - Country:US
Practice Address - Phone:706-868-8998
Practice Address - Fax:706-868-1071
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0229382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000269288BMedicaid
GA000269288BMedicaid