Provider Demographics
NPI:1518459940
Name:LOTUS PRIMARY CARE, PC
Entity Type:Organization
Organization Name:LOTUS PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHRAVANTIKA
Authorized Official - Middle Name:BAIMEEDI
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-239-8005
Mailing Address - Street 1:1670 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6585
Mailing Address - Country:US
Mailing Address - Phone:470-239-8005
Mailing Address - Fax:949-543-2365
Practice Address - Street 1:1670 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6585
Practice Address - Country:US
Practice Address - Phone:470-239-8005
Practice Address - Fax:949-543-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066310261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care