Provider Demographics
NPI:1215967211
Name:BEHARI, PRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:BEHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-429-0083
Mailing Address - Fax:770-425-0137
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-429-0083
Practice Address - Fax:770-425-0137
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106904207RI0200X, 207R00000X
GA65338207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106904Medicaid
IL1574004Medicare PIN
IL036106904Medicaid
K07603Medicare UPIN
IL1573004Medicare PIN
ILK19342Medicare ID - Type Unspecified
IL1566004Medicare PIN