Provider Demographics
NPI:1407476914
Name:NAGAREDDY, BHAVANA (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANA
Middle Name:
Last Name:NAGAREDDY
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 1:193 N PARK TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7373
Mailing Address - Country:US
Mailing Address - Phone:770-389-0116
Mailing Address - Fax:770-389-4058
Practice Address - Street 1:193 N PARK TRL STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7373
Practice Address - Country:US
Practice Address - Phone:770-389-0116
Practice Address - Fax:770-389-4058
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics