Provider Demographics
NPI:1972330975
Name:LAKSHMANA PERUMAL, SHIVAPRIYA
Entity type:Individual
Prefix:
First Name:SHIVAPRIYA
Middle Name:
Last Name:LAKSHMANA PERUMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 DALLAS HWY SW STE 202
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-7505
Mailing Address - Country:US
Mailing Address - Phone:470-588-8484
Mailing Address - Fax:855-915-0244
Practice Address - Street 1:450 FRANKLIN GTWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7749
Practice Address - Country:US
Practice Address - Phone:470-588-8484
Practice Address - Fax:855-915-0244
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-358095106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician