Provider Demographics
NPI:1568413060
Name:CHENNAREDDY, SANTHI P (MD)
Entity Type:Individual
Prefix:
First Name:SANTHI
Middle Name:P
Last Name:CHENNAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 STATE ROAD 64
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0038
Mailing Address - Country:US
Mailing Address - Phone:812-949-5482
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE STE 500
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:770-297-5023
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061425A207Q00000X
GA82141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00306208OtherRR MEDICARE
000000387032OtherANTHEM BCBS
IN200803790Medicaid
G41463Medicare UPIN
IN200803790Medicaid