Provider Demographics
NPI:1669442711
Name:REDDY, PRINGLE PRITHVI (MD)
Entity Type:Individual
Prefix:
First Name:PRINGLE
Middle Name:PRITHVI
Last Name:REDDY
Suffix:
Gender:M
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:PO BOX 402145
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2145
Mailing Address - Country:US
Mailing Address - Phone:803-296-7313
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:1 RICHLAND MEDICAL PARK
Practice Address - Street 2:SUITE 230
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6834
Practice Address - Country:US
Practice Address - Phone:803-434-3533
Practice Address - Fax:803-434-3094
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC102102086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102105Medicaid
SC102105Medicaid