Provider Demographics
NPI:1033770771
Name:YOUR HOSPITALIST TEAM LLC
Entity Type:Organization
Organization Name:YOUR HOSPITALIST TEAM LLC
Other - Org Name:DR. REDDY'S LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RASAMALLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-379-8553
Mailing Address - Street 1:2215 AUTUMN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 AUTUMN RIDGE LN
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1358
Practice Address - Country:US
Practice Address - Phone:210-379-8553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty