Provider Demographics
NPI:1619949773
Name:SAPPATI, SHAILAJA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILAJA
Middle Name:R
Last Name:SAPPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAILAJA
Other - Middle Name:R
Other - Last Name:BODAPATLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 MEDICAL WAY
Mailing Address - Street 2:RADIOLOGY DEPT.
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2195
Mailing Address - Country:US
Mailing Address - Phone:770-979-0200
Mailing Address - Fax:770-736-2335
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:770-979-0200
Practice Address - Fax:770-736-2335
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1257912085R0202X
GA0588192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101001408Medicaid
PA101001408Medicaid
PAI06434Medicare UPIN