Provider Demographics
NPI:1528043239
Name:REDDY, MADADI GOVIND (MD)
Entity Type:Individual
Prefix:DR
First Name:MADADI
Middle Name:GOVIND
Last Name:REDDY
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 1:331 PARKS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2411
Mailing Address - Country:US
Mailing Address - Phone:256-259-4745
Mailing Address - Fax:256-474-4388
Practice Address - Street 1:331 PARKS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2411
Practice Address - Country:US
Practice Address - Phone:256-259-4745
Practice Address - Fax:256-474-4388
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003879Medicaid
AL000003879Medicare ID - Type UnspecifiedALABAMA MEDICARE NUMBER
AL000003879Medicaid