Provider Demographics
NPI:1265497465
Name:REDDY, MAHENDER (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDER
Middle Name:
Last Name:REDDY
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 1:3970 DEPUTY BILL CANTRELL MEM STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3069
Mailing Address - Country:US
Mailing Address - Phone:678-513-2273
Mailing Address - Fax:678-513-8869
Practice Address - Street 1:3970 DEPUTY BILL CANTRELL MEM
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3069
Practice Address - Country:US
Practice Address - Phone:678-513-2273
Practice Address - Fax:678-513-8869
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6486207RC0000X
GA83848207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051512621Medicaid
ALC71765Medicare UPIN
AL51512621REDMedicare ID - Type UnspecifiedMEDICARE/BCBS PROVIDER NO