Provider Demographics
NPI:1891706974
Name:ERRAMILLI, SYAMALA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:SYAMALA
Middle Name:D
Last Name:ERRAMILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2926 MOUNTAIN INDUSTRIAL BLVD.
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:678-971-2020
Mailing Address - Fax:678-666-1300
Practice Address - Street 1:2926 MOUNTAIN INDUSTRIAL BLVD.
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:678-971-2020
Practice Address - Fax:678-666-1300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87962Medicare UPIN