Provider Demographics
NPI:1386821726
Name:SIDDAPPA, JALAJA P (MD)
Entity Type:Individual
Prefix:
First Name:JALAJA
Middle Name:P
Last Name:SIDDAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JALAJA
Other - Middle Name:
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 370407
Mailing Address - Street 2:PATIENT ACCOUNTS OFFICE
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30037-0407
Mailing Address - Country:US
Mailing Address - Phone:404-212-5454
Mailing Address - Fax:404-243-2159
Practice Address - Street 1:3073 PANTHERSVILLE RD
Practice Address - Street 2:PATIENT ACCOUNTS
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3828
Practice Address - Country:US
Practice Address - Phone:404-212-5454
Practice Address - Fax:404-243-2159
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS1374191OtherDEA