Provider Demographics
NPI:1235533001
Name:ALPHA OBGYN INC
Entity Type:Organization
Organization Name:ALPHA OBGYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SOWMYA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-335-9223
Mailing Address - Street 1:2905 JORDAN CT STE G
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8966
Mailing Address - Country:US
Mailing Address - Phone:678-335-9223
Mailing Address - Fax:678-335-9236
Practice Address - Street 1:2905 JORDAN CT
Practice Address - Street 2:SUITE G
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:678-335-9223
Practice Address - Fax:678-335-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060596207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA450094819EMedicaid
202I164160OtherWELLCARE PTAN
GA569399OtherWELLCARE