Provider Demographics
NPI:1881607000
Name:CENTA, VANDANA CHAKRAVARTHY (DO)
Entity type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:CHAKRAVARTHY
Last Name:CENTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:VANDANA
Other - Middle Name:SREENATHAN
Other - Last Name:CHAKRAVARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:706-788-3234
Mailing Address - Fax:706-788-2936
Practice Address - Street 1:11 CHARLIE MORRIS RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:GA
Practice Address - Zip Code:30628-2445
Practice Address - Country:US
Practice Address - Phone:706-788-3234
Practice Address - Fax:706-788-2936
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057054207R00000X
AZ3099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA136315049CMedicaid
GA136315049CMedicaid
AZG31772Medicare UPIN