Provider Demographics
NPI:1467418087
Name:REDDY, SRIKAR S (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIKAR
Middle Name:S
Last Name:REDDY
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 1:1222 TROTWOOD AVENUE
Mailing Address - Street 2:STE 501
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6422
Mailing Address - Country:US
Mailing Address - Phone:931-388-8302
Mailing Address - Fax:931-388-9540
Practice Address - Street 1:1222 TROTWOOD AVENUE
Practice Address - Street 2:STE 501
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6422
Practice Address - Country:US
Practice Address - Phone:931-388-8302
Practice Address - Fax:931-388-9540
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27993207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702673Medicaid
TN3800343Medicaid
F29135Medicare UPIN
TN3800343Medicaid
TN3702673Medicaid