Basic Information
| Provider Information | |||||||||
| NPI: | 1376786871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIDELLA | ||||||||
| FirstName: | SHAILAJA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1649 MCFARLAND BLVD N | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354062281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055565541 | ||||||||
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| Practice Location | |||||||||
| Address1: | 595 HURRICANE SHOALS RD NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046457150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 79107 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 33362 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.