Provider Demographics
NPI:1437123585
Name:MADICHETTY, HARI GOPAL (MD, FCCP, D-ABSM)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:GOPAL
Last Name:MADICHETTY
Suffix:
Gender:M
Credentials:MD, FCCP, D-ABSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604A S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4214
Mailing Address - Country:US
Mailing Address - Phone:770-227-1999
Mailing Address - Fax:
Practice Address - Street 1:604A S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4214
Practice Address - Country:US
Practice Address - Phone:770-227-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA919846878AMedicaid
I07854Medicare UPIN
GA81BBBCQMedicare ID - Type Unspecified