Provider Demographics
NPI:1871530139
Name:DEVU, INDIRA (MD)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:DEVU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WINDY HILL RD SE STE 306
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8653
Mailing Address - Country:US
Mailing Address - Phone:770-955-1814
Mailing Address - Fax:770-955-2279
Practice Address - Street 1:2520 WINDY HILL RD SE STE 306
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8653
Practice Address - Country:US
Practice Address - Phone:770-955-1814
Practice Address - Fax:770-955-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA279474230BMedicaid
GA279474230BMedicaid