Provider Demographics
NPI:1619054582
Name:MEREDDY, RAVIPRAKASH REDDY (DMD)
Entity Type:Individual
Prefix:
First Name:RAVIPRAKASH
Middle Name:REDDY
Last Name:MEREDDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-0906
Mailing Address - Country:US
Mailing Address - Phone:706-629-8822
Mailing Address - Fax:706-629-8893
Practice Address - Street 1:908 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1969
Practice Address - Country:US
Practice Address - Phone:706-629-8822
Practice Address - Fax:706-629-8893
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA905675835AMedicaid