Provider Demographics
NPI:1497773535
Name:REDDY, GOLLAMUDI H I (MD)
Entity Type:Individual
Prefix:DR
First Name:GOLLAMUDI
Middle Name:H
Last Name:REDDY
Suffix:I
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 1:1527 GAUSE BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2244
Mailing Address - Country:US
Mailing Address - Phone:985-781-5600
Mailing Address - Fax:985-781-5601
Practice Address - Street 1:2375 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4142
Practice Address - Country:US
Practice Address - Phone:985-781-5600
Practice Address - Fax:985-781-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08804R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1918105Medicaid
LA5N614Medicare PIN
LA1918105Medicaid