Provider Demographics
NPI:1578690467
Name:JONNALA, GEETHA (MD)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:
Last Name:JONNALA
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 1:1567 JANMAR RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-972-1022
Mailing Address - Fax:770-407-8485
Practice Address - Street 1:1567 JANMAR RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-972-1022
Practice Address - Fax:770-407-8485
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM5258207RR0500X
GA059086207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology