Provider Demographics
NPI:1497953582
Name:MADDINENI HOLDINGS LLC
Entity Type:Organization
Organization Name:MADDINENI HOLDINGS LLC
Other - Org Name:HEALTH STAR FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSUNURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-932-7605
Mailing Address - Street 1:4485 TENCH RD
Mailing Address - Street 2:SUITE NO 120
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6739
Mailing Address - Country:US
Mailing Address - Phone:770-932-7605
Mailing Address - Fax:
Practice Address - Street 1:4485 TENCH RD
Practice Address - Street 2:SUITE NO 120
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6739
Practice Address - Country:US
Practice Address - Phone:770-932-7605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G701213OtherMEDICARE RAILROAD
GAAPPLIED FOROtherMEDICARE NO APPLIED FOR