Provider Demographics
NPI:1437436094
Name:C. B. REDDY MD PC
Entity Type:Organization
Organization Name:C. B. REDDY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELUKALA
Authorized Official - Middle Name:BAFU
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-228-9719
Mailing Address - Street 1:610 S 8TH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224
Mailing Address - Country:US
Mailing Address - Phone:770-228-9719
Mailing Address - Fax:770-228-8244
Practice Address - Street 1:610 S 8TH STREET
Practice Address - Street 2:SUITE F
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-228-9719
Practice Address - Fax:770-228-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27431305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00325102AMedicaid
GA00325102AMedicaid