Provider Demographics
NPI:1194815795
Name:GUNDLAPALLI, ADISESHU V (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ADISESHU
Middle Name:V
Last Name:GUNDLAPALLI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ADI
Other - Middle Name:V
Other - Last Name:GUNDLAPALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:5815 PINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5225
Mailing Address - Country:US
Mailing Address - Phone:018-473-6628
Mailing Address - Fax:
Practice Address - Street 1:1605 CHANTILLY DR NE STE 392
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3267
Practice Address - Country:US
Practice Address - Phone:404-778-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84117207RI0001X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00440570OtherRAILROAD MEDICARE
UT000061705Medicare PIN