Provider Demographics
NPI:1407809122
Name:SINGAREDDY, RAVI KUMAR R (MD)
Entity Type:Individual
Prefix:
First Name:RAVI KUMAR
Middle Name:R
Last Name:SINGAREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 PEACHTREE PKWY STE E-359
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6034
Mailing Address - Country:US
Mailing Address - Phone:770-615-0226
Mailing Address - Fax:770-800-2018
Practice Address - Street 1:3890 JOHNS CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1286
Practice Address - Country:US
Practice Address - Phone:770-615-0226
Practice Address - Fax:770-800-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77783207RS0012X, 2084S0012X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010248790001Medicaid
PA1010248790001Medicaid
PA82163Medicare ID - Type Unspecified