Provider Demographics
NPI:1427000959
Name:TUMMALA, PRADYUMNA E (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADYUMNA
Middle Name:E
Last Name:TUMMALA
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 1:1110 W PEACHTREE ST NW STE 920
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3609
Mailing Address - Country:US
Mailing Address - Phone:404-962-6000
Mailing Address - Fax:404-962-6001
Practice Address - Street 1:1110 W PEACHTREE ST NW STE 920
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:404-962-6000
Practice Address - Fax:404-962-6001
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041016207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA06BDHCBOtherMEDICARE ID
GA00685209BMedicaid
GA00685209BMedicaid