Provider Demographics
NPI:1699432591
Name:VALLIKATTIL GOPI, SREEJU (AGACNP)
Entity type:Individual
Prefix:
First Name:SREEJU
Middle Name:
Last Name:VALLIKATTIL GOPI
Suffix:
Gender:
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY ST JOSEPH HOSPITAL
Mailing Address - Street 2:5665 PEACHTREE DUNWOODY RD
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:678-843-5331
Mailing Address - Fax:
Practice Address - Street 1:EMORY ST JOSEPH HOSPITAL
Practice Address - Street 2:5665 PEACHTREE DUNWOODY RD
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:678-843-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225944163W00000X
GARN334247363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse