Provider Demographics
NPI:1588727952
Name:SUBRAMANIAN, LAVANYA (MD)
Entity type:Individual
Prefix:
First Name:LAVANYA
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 HICKORY STREET
Mailing Address - Street 2:STE 406
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-270-5002
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:191 LAMAR HALEY PARKWAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8019
Practice Address - Country:US
Practice Address - Phone:770-704-1600
Practice Address - Fax:770-704-1610
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0361222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF41163Medicare UPIN