Provider Demographics
NPI:1376925503
Name:ADDAGATLA, SWETHA
Entity Type:Individual
Prefix:
First Name:SWETHA
Middle Name:
Last Name:ADDAGATLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11379 SOUTHBRIDGE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4402
Mailing Address - Country:US
Mailing Address - Phone:770-777-0750
Mailing Address - Fax:770-777-0521
Practice Address - Street 1:11379 SOUTHBRIDGE PKWY STE A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4402
Practice Address - Country:US
Practice Address - Phone:770-777-0750
Practice Address - Fax:770-777-0521
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79924207Q00000X
AL390200000X
GA079924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program