Provider Demographics
NPI:1285624148
Name:AYINALA, SRINIVASA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:RAO
Last Name:AYINALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1355 PEACHTREE ST NE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3276
Mailing Address - Country:US
Mailing Address - Phone:678-223-7774
Mailing Address - Fax:678-223-7799
Practice Address - Street 1:301 PHILIP BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-822-5560
Practice Address - Fax:770-822-4989
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA052531207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA174126432BMedicaid
GAH04292Medicare UPIN
GA10BDHHZMedicare ID - Type Unspecified