Provider Demographics
NPI:1689623415
Name:REDDY, RAMANA MAREPALLY (MD)
Entity Type:Individual
Prefix:
First Name:RAMANA
Middle Name:MAREPALLY
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 150
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0004
Mailing Address - Country:US
Mailing Address - Phone:678-689-1100
Mailing Address - Fax:706-612-1620
Practice Address - Street 1:601A PROFESSIONAL DRIVE
Practice Address - Street 2:STE. 130
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3325
Practice Address - Country:US
Practice Address - Phone:770-551-7800
Practice Address - Fax:770-551-7802
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057010173000000X
GA57010207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE05858Medicare UPIN