Basic Information
| Provider Information | |||||||||
| NPI: | 1609434281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOWDAVARAPU | ||||||||
| FirstName: | SHALINI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NE IA FAMILY PRACTICE CENTER | ||||||||
| Address2: | 2055 KIMBALL AVE. STE. 101 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192722112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2959 SHARPSBURG MCCULLUM RD STE A6 | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786333260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2019 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-11431 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 91845 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.