Madhuri P Basavaraju, M.D.
Individual provider Active NPI Pediatrics Physician · Duluth, GA
NPI 1497932685 · NPPES record last updated Jan 28, 2010
Key facts
- NPI
- 1497932685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 062947 (GA)
- Practice address
- 3650 Steve Reynolds Boulevard
Kaiser Permanente Gwinnett Medical Office
Duluth, GA 30096 - Phone
- (770) 931-6010
- NPI assigned
- Jan 30, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100325000419 | GA | Practitioner - Pediatric Medicine | 4385770767 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062947 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Southeast Permanente Medical Group | Pediatrics | Current |
Accepting new patients |
Locations
3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000
3650 Steve Reynolds Blvd
Ofc
Duluth, GA 30096
Phone (770) 931-6010
5440 Hillandale Dr
Lithonia, GA 30058
Phone (770) 322-2716
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 002102 | GA | |
| Pediatrics Physician | 208000000X | 062947 | GA | Yes |
Addresses
Primary practice location
3650 Steve Reynolds Boulevard
Kaiser Permanente Gwinnett Medical Office
Duluth, GA 30096
Mailing address
3495 Piedmont Road NE
Nine Piedmont Center
Atlanta, GA 30305
Phone (404) 364-7070
Other names
- Mrs. Madhuri Putcha
Other providers in Duluth, GA
- Purnima Bansal
- Erjia Bao
- Margaret Barnard
- Sara Barr
- Kimberley Yatzary Barrera
- Cheryl A Basden
- Jennifer Michelle Bastecki
- Maria Batlle
- Robert Erich Bauman
- Be the Light Chiropractic
All providers in Duluth, GA · Pediatrics Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.