Provider Demographics
NPI:1851366454
Name:VENKATESH, JAYASHREE (MD)
Entity Type:Individual
Prefix:
First Name:JAYASHREE
Middle Name:
Last Name:VENKATESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYASHREE
Other - Middle Name:VENUGOPAL
Other - Last Name:PURUSHOTHAMALU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:540-636-8920
Practice Address - Street 1:1435 BROADMOOR BLVD
Practice Address - Street 2:KAISER PERMANENTE SUGAR HILL-BUFORD MEDICAL CENTER
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:678-765-5700
Practice Address - Fax:540-636-8920
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237911207Q00000X
GA065912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00670504OtherMEDICARE RR
VA010147735Medicaid
VA010147735Medicaid
VAI30226Medicare UPIN
VAMC10235Medicare PIN