Provider Demographics
NPI:1144225293
Name:REDDY, BHAGAT K (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAGAT
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 PEACHTREE DUNWOODY RD STE A150
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5944
Mailing Address - Country:US
Mailing Address - Phone:404-996-6596
Mailing Address - Fax:
Practice Address - Street 1:14244 HIGHWAY 515 N STE 100
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-2029
Practice Address - Country:US
Practice Address - Phone:404-996-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055012207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA983326893AMMedicaid
GA983326893FGNOPQRSMedicaid
GA983326893FGNOPQRSMedicaid