Provider Demographics
NPI:1558416198
Name:SMYRNA MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SMYRNA MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE & GERIATRICS
Authorized Official - Prefix:
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-303-5082
Mailing Address - Street 1:3606 HIGHLANDS PKWY SE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5184
Mailing Address - Country:US
Mailing Address - Phone:678-303-5082
Mailing Address - Fax:
Practice Address - Street 1:3606 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:678-303-5082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051069207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty