Provider Demographics
NPI:1700827458
Name:BRAHMADEVI, SOWMYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOWMYA
Middle Name:
Last Name:BRAHMADEVI
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 1:1058 BEAR CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-1849
Mailing Address - Country:US
Mailing Address - Phone:770-707-0808
Mailing Address - Fax:770-707-1580
Practice Address - Street 1:2612 HOLCOMB BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5494
Practice Address - Country:US
Practice Address - Phone:770-650-8980
Practice Address - Fax:770-650-5589
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073444207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38957972Medicare PIN
TNI9057Medicare UPIN
TN38957972Medicare PIN
TN4172557OtherBCBS TN
MS01208261Medicaid
TNI9057Medicare UPIN