Provider Demographics
NPI:1508942319
Name:CHALLA, HARIGOVINDA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:HARIGOVINDA
Middle Name:REDDY
Last Name:CHALLA
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 1:975 E 3RD ST
Mailing Address - Street 2:BOX 376
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-6213
Mailing Address - Fax:423-778-6299
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:BOX 376
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-6213
Practice Address - Fax:423-778-6299
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY429352085P0229X, 2085R0202X
TN503722085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8806895Medicaid
321630OtherINTERNAL ID-MOTOR VEHICLE ID
KY7100094300Medicaid
321630OtherINTERNAL ID-MOTOR VEHICLE ID
KY7100094300Medicaid