Provider Demographics
NPI:1265711394
Name:SREERAMAN KUMAR, RADHIKA (MD)
Entity type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:SREERAMAN KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RADHIKA
Other - Middle Name:
Other - Last Name:SREERAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:725 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-228-3737
Practice Address - Fax:770-228-9334
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0765712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003179047Medicaid