Provider Demographics
NPI:1083141477
Name:DEVIREDDY, NITHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NITHIN
Middle Name:
Last Name:DEVIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7812
Mailing Address - Country:US
Mailing Address - Phone:512-796-6476
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN STREET MARKET PL SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-3309
Practice Address - Country:US
Practice Address - Phone:702-742-3454
Practice Address - Fax:770-334-2551
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA89193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program