Provider Demographics
NPI:1467549840
Name:REDDY, CHELUKALA BAPU (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELUKALA
Middle Name:BAPU
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:610 S 8TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4201
Mailing Address - Country:US
Mailing Address - Phone:770-228-9719
Mailing Address - Fax:770-228-8244
Practice Address - Street 1:610 S 8TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4201
Practice Address - Country:US
Practice Address - Phone:770-228-9719
Practice Address - Fax:770-228-8244
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA27431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00325102AMedicaid
GA00325102AMedicaid
GAD40942Medicare UPIN