Provider Demographics
NPI:1639167299
Name:GORJALA, SRINIVASA KUMAR (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:KUMAR
Last Name:GORJALA
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:6135 BARFIELD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4309
Mailing Address - Country:US
Mailing Address - Phone:404-250-6691
Mailing Address - Fax:404-250-8847
Practice Address - Street 1:6135 BARFIELD RD STE 150
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4309
Practice Address - Country:US
Practice Address - Phone:404-250-6691
Practice Address - Fax:404-250-8847
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA043378208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00749625AMedicaid
GA00749625AMedicaid
GA00749625AMedicaid