Provider Demographics
NPI:1366850588
Name:KOTHAPALLY, SWACHITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SWACHITHA
Middle Name:
Last Name:KOTHAPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3850 WINDERMERE PKWY
Mailing Address - Street 2:STE 105
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7002
Mailing Address - Country:US
Mailing Address - Phone:678-455-2800
Mailing Address - Fax:770-888-9998
Practice Address - Street 1:3850 WINDERMERE PKWY
Practice Address - Street 2:STE 105
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7002
Practice Address - Country:US
Practice Address - Phone:678-455-2800
Practice Address - Fax:770-888-9998
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA077170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program