Provider Demographics
NPI:1093872558
Name:SOODINI, GEETHA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:REDDY
Last Name:SOODINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEETHA
Other - Middle Name:REDDY
Other - Last Name:SOODINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11585 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 420-127
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8129
Mailing Address - Country:US
Mailing Address - Phone:770-886-3842
Mailing Address - Fax:770-886-3843
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:SUITE 2800
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-886-3842
Practice Address - Fax:770-886-3843
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059025207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA207RE0101XOtherTAXONOMY
GA770-844-8428OtherCONTACT PERSON
GA207RE0101XOtherTAXONOMY