Provider Demographics
NPI:1578681102
Name:REDDY, ANITHA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANITHA
Middle Name:R
Last Name:REDDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANITHA
Other - Middle Name:R
Other - Last Name:RAMASAHAYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4139 BAKER ST NE
Mailing Address - Street 2:SUITE# 15
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-1405
Mailing Address - Country:US
Mailing Address - Phone:770-787-1013
Mailing Address - Fax:770-787-1018
Practice Address - Street 1:4139 BAKER ST NE
Practice Address - Street 2:SUITE# 15
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1405
Practice Address - Country:US
Practice Address - Phone:770-787-1013
Practice Address - Fax:770-787-1018
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice