Provider Demographics
NPI:1275736993
Name:REDDY, MADHU C (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:C
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MADHUKAR
Other - Middle Name:
Other - Last Name:CHELAMCHARLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11810 NORTHFALL LN STE 1202
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7975
Mailing Address - Country:US
Mailing Address - Phone:770-663-8766
Mailing Address - Fax:770-663-8767
Practice Address - Street 1:11810 NORTHFALL LN STE 1202
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7975
Practice Address - Country:US
Practice Address - Phone:770-663-8766
Practice Address - Fax:770-663-8767
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059385207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA154427215BMedicaid
GA202I399230Medicare PIN