Active NPI
Swayamprabha S Tyagi, MD
- Pediatrics Physician
- Vidalia, GA
National Provider Identifier
1720134166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 32318
- Practice address
- 414 Lugenia Dr
Vidalia, GA 30474-7210 - Phone
- (912) 537-9355
- Fax
- (912) 537-7038
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 32318 | GA | Primary |
| Pediatrics Physician | 208000000X | 47063 | AZ |
Addresses
Primary practice location
414 Lugenia Dr
Vidalia, GA 30474-7210
Mailing address
414 Lugenia Dr
Vidalia, GA 30474-7210
Phone (912) 537-9355
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000517833F | Medicaid | GA | |
| 000517833H | Medicaid | GA | |
| 000517833B | Medicaid | GA | |
| 000517833I | Medicaid | GA |
Other names 1
- Swayamprabha Subramaniam Iyer
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32318 | GA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479168000000",
"number": "1720134166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 LUGENIA DR",
"city": "VIDALIA",
"state": "GA",
"postal_code": "304747210",
"telephone_number": "912-537-9355",
"fax_number": "912-537-7038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 LUGENIA DR",
"city": "VIDALIA",
"state": "GA",
"postal_code": "304747210",
"telephone_number": "912-537-9355",
"fax_number": "912-537-7038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYAGI",
"first_name": "SWAYAMPRABHA",
"middle_name": "S",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2016-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "32318",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "47063",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000517833F",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000517833H",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000517833B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000517833I",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SWAYAMPRABHA",
"last_name": "IYER",
"middle_name": "SUBRAMANIAM",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Vidalia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.