Provider Demographics
NPI:1255437075
Name:ARIKATLA, HARITHA (MD)
Entity type:Individual
Prefix:MRS
First Name:HARITHA
Middle Name:
Last Name:ARIKATLA
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 1:3580 GLENAIREVIEW CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5405
Mailing Address - Country:US
Mailing Address - Phone:678-591-6643
Mailing Address - Fax:
Practice Address - Street 1:1515 RIVER PL
Practice Address - Street 2:SUIT 200
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5602
Practice Address - Country:US
Practice Address - Phone:770-848-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55723207R00000X
GA055723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055723OtherLICENSE