Provider Demographics
NPI:1659543130
Name:SIDDHANTHI, MADHAVI LATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:LATHA
Last Name:SIDDHANTHI
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 1:700 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7220
Mailing Address - Country:US
Mailing Address - Phone:770-420-1690
Mailing Address - Fax:
Practice Address - Street 1:355 TOWER RD NE STE 103
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9410
Practice Address - Country:US
Practice Address - Phone:770-420-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101944207R00000X
GAA69137207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine