Provider Demographics
NPI:1679754337
Name:SY MED LLC
Entity type:Organization
Organization Name:SY MED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYAMALA
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:ERRAMILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-860-5416
Mailing Address - Street 1:2926 MOUNTAIN INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3012
Mailing Address - Country:US
Mailing Address - Phone:678-971-2020
Mailing Address - Fax:678-666-1300
Practice Address - Street 1:9105 ETCHING OVERLOOK
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-6412
Practice Address - Country:US
Practice Address - Phone:678-860-5415
Practice Address - Fax:678-666-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7406Medicare PIN