Provider Demographics
NPI:1215556790
Name:SRINIVAS, SINDHU
Entity type:Individual
Prefix:
First Name:SINDHU
Middle Name:
Last Name:SRINIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 JOE FRANK HARRIS PKWY SE BLDG A106
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2151
Mailing Address - Country:US
Mailing Address - Phone:770-386-1389
Mailing Address - Fax:770-386-4894
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE BLDG A106
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2151
Practice Address - Country:US
Practice Address - Phone:770-386-1389
Practice Address - Fax:770-386-4894
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC007124208600000X
GAPOD305038213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery