Basic Information
Provider Information
NPI: 1700827458
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRAHMADEVI
FirstName: SOWMYA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1058 BEAR CREEK BLVD
Address2:  
City: HAMPTON
State: GA
PostalCode: 302281849
CountryCode: US
TelephoneNumber: 7707070808
FaxNumber: 7707071580
Practice Location
Address1: 2612 HOLCOMB BRIDGE RD STE 100
Address2:  
City: ALPHARETTA
State: GA
PostalCode: 300225494
CountryCode: US
TelephoneNumber: 7706508980
FaxNumber: 7706505589
Other Information
ProviderEnumerationDate: 06/10/2006
LastUpdateDate: 10/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X073444GAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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