Provider Demographics
NPI:1710428305
Name:ENDOHEALTH
Entity Type:Organization
Organization Name:ENDOHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYATHRI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEVINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-829-6030
Mailing Address - Street 1:240 GLEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 207
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7778
Practice Address - Country:US
Practice Address - Phone:678-829-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0615732080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1619154184OtherNUPIN