Provider Demographics
NPI:1629396585
Name:PARVATHANENI, LATA (MD)
Entity Type:Individual
Prefix:DR
First Name:LATA
Middle Name:
Last Name:PARVATHANENI
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 1:900 TOWNE LAKE PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1604
Mailing Address - Country:US
Mailing Address - Phone:678-445-0819
Mailing Address - Fax:678-445-0927
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 410
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:678-445-0819
Practice Address - Fax:678-445-0927
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082875Medicaid
OH0082875Medicaid
OHH203890Medicare PIN