Provider Demographics
NPI:1588673776
Name:MADADI G. REDDY, MD PC
Entity Type:Organization
Organization Name:MADADI G. REDDY, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MADADI
Authorized Official - Middle Name:GOVIND
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-4745
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:256-259-5598
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:256-259-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003879OtherBCBS OF ALABAMA PROVIDER
ALC73949Medicare UPIN