Provider Demographics
NPI:1629463864
Name:DEVAPRIYA, INOKA ABEYSIRI (MD)
Entity Type:Individual
Prefix:DR
First Name:INOKA
Middle Name:ABEYSIRI
Last Name:DEVAPRIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:INOKA
Other - Middle Name:ABEYSIRI
Other - Last Name:SAMARASEKARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MYRTLE BLVD
Mailing Address - Street 2:103B
Mailing Address - City:GRACEWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30812
Mailing Address - Country:US
Mailing Address - Phone:706-790-2011
Mailing Address - Fax:
Practice Address - Street 1:100 MYRTLE BLVD
Practice Address - Street 2:103B
Practice Address - City:GRACEWOOD
Practice Address - State:GA
Practice Address - Zip Code:30812
Practice Address - Country:US
Practice Address - Phone:706-790-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT208551208600000X
390200000X
GA077723208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program