Provider Demographics
NPI:1295829059
Name:REDDY, SOWMYA (MD)
Entity Type:Individual
Prefix:
First Name:SOWMYA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 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 STE G
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8966
Practice Address - Country:US
Practice Address - Phone:678-335-9223
Practice Address - Fax:678-335-9236
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060596207V00000X
OH35088620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I164160OtherMEDICARE PTAN
GA569399OtherWELLCARE
GA450094819EMedicaid