Provider Demographics
NPI:1689611329
Name:PRASAD, JAYARAM D (MD)
Entity Type:Individual
Prefix:
First Name:JAYARAM
Middle Name:D
Last Name:PRASAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2788 BAYARD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3441
Mailing Address - Country:US
Mailing Address - Phone:404-768-3043
Mailing Address - Fax:404-768-1781
Practice Address - Street 1:2788 BAYARD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3441
Practice Address - Country:US
Practice Address - Phone:404-768-3043
Practice Address - Fax:404-768-1781
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00705592DMedicaid
E13846Medicare UPIN