Provider Demographics
NPI:1427095082
Name:SIVASWAMY, LALITHA (MD)
Entity type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:
Last Name:SIVASWAMY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 FORSYTH ST STE 360
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2051
Mailing Address - Country:US
Mailing Address - Phone:248-895-3518
Mailing Address - Fax:
Practice Address - Street 1:1014 FORSYTH ST STE 360
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2051
Practice Address - Country:US
Practice Address - Phone:248-895-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1031392084N0402X
MI43010622612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology