Provider Demographics
NPI:1730172016
Name:IYER, SHANTHALAXMI R (MD)
Entity type:Individual
Prefix:
First Name:SHANTHALAXMI
Middle Name:R
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANTHALAXMI
Other - Middle Name:N
Other - Last Name:MOOTERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3579 HIGHWAY 138
Mailing Address - Street 2:STE 103
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4142
Mailing Address - Country:US
Mailing Address - Phone:678-565-3300
Mailing Address - Fax:678-565-3311
Practice Address - Street 1:3579 HIGHWAY 138
Practice Address - Street 2:STE 103
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4142
Practice Address - Country:US
Practice Address - Phone:678-565-3300
Practice Address - Fax:678-565-3311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0518362083P0901X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine