Provider Demographics
NPI:1770562852
Name:JAYANTHI, NEERU (MD)
Entity type:Individual
Prefix:
First Name:NEERU
Middle Name:
Last Name:JAYANTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(1211 ROOSEVELT RD., MAYWOOD, IL. 60153)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-531-5200
Mailing Address - Fax:708-531-5201
Practice Address - Street 1:6335 HOSPITAL PKWY STE 302
Practice Address - Street 2:EMORY ORTHOPAEDICS, SPORTS, SPINE
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5712
Practice Address - Country:US
Practice Address - Phone:404-778-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073815207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA073815Medicaid
H92330Medicare UPIN
H92330Medicare UPIN