Provider Demographics
NPI:1992722920
Name:VELIYATH, JAYASHREE C (MD)
Entity type:Individual
Prefix:MRS
First Name:JAYASHREE
Middle Name:C
Last Name:VELIYATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2155 POST OAK TRITT RD
Mailing Address - Street 2:STE580
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8620
Mailing Address - Country:US
Mailing Address - Phone:770-971-0633
Mailing Address - Fax:770-971-3182
Practice Address - Street 1:2155 POST OAK TRITT RD
Practice Address - Street 2:STE580
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8620
Practice Address - Country:US
Practice Address - Phone:770-971-0633
Practice Address - Fax:770-971-3182
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAK38638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11BDRKJMedicare ID - Type Unspecified
GAE68240Medicare UPIN