Provider Demographics
NPI:1225087406
Name:SRIPATHI, KARUNAKER REDDY (MD)
Entity Type:Individual
Prefix:
First Name:KARUNAKER
Middle Name:REDDY
Last Name:SRIPATHI
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 1:209 WES PARK DRIVE
Mailing Address - Street 2:PERRY PRIMARY CARE
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069
Mailing Address - Country:US
Mailing Address - Phone:478-987-2578
Mailing Address - Fax:478-987-2598
Practice Address - Street 1:209 WES PARK DRIVE
Practice Address - Street 2:PERRY PRIMARY CARE
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069
Practice Address - Country:US
Practice Address - Phone:478-987-2578
Practice Address - Fax:478-987-2598
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000771251DMedicaid
GA11SCDXSMedicare PIN
GA000771251DMedicaid