Provider Demographics
NPI:1619154184
Name:DEVINENI, GAYATHRI K (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYATHRI
Middle Name:K
Last Name:DEVINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYATHRI
Other - Middle Name:K
Other - Last Name:DEVINENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:240 GLEN LAKE DR
Mailing Address - Street 2:ATLANTA
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4818
Mailing Address - Country:US
Mailing Address - Phone:678-756-3423
Mailing Address - Fax:
Practice Address - Street 1:135 VANN ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7249
Practice Address - Country:US
Practice Address - Phone:678-829-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0615732080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1710428305OtherNPI TYPE II
GA709382690AMedicaid