Provider Demographics
NPI:1063633782
Name:CHAVA, SOUJANYA (MD)
Entity type:Individual
Prefix:DR
First Name:SOUJANYA
Middle Name:
Last Name:CHAVA
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 1:743 SPRING ST NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3715
Mailing Address - Country:US
Mailing Address - Phone:770-219-6000
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432268207R00000X, 208M00000X
GA075145208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9120068OtherAETNA
PA1976337OtherHIGHMARK BLUE SHIELD
PA211425OtherJOHNS HOPKINS
PA220614OtherUNISON-WMG
PA30131831OtherAMERIHEALTH MERCY - WMG
PA110901OtherGEISINGER
MD900389OtherCAREFIRST MD BCBS
MD033797800OtherMARYLAND MEDICAL ASSISTANCE-WMG
PA1564186OtherGATEWAY-WMG
2161248OtherMAMSI-WMG
PA50071108OtherCAPITAL BLUE CROSS-WMG
PA101960373Medicaid
PA20090413OtherAMERIHEALTH MERCY-WMG
PA114424EZ3Medicare PIN
PA114424FLTMedicare PIN
PA50071108OtherCAPITAL BLUE CROSS-WMG