Provider Demographics
NPI:1760519557
Name:REDDY, RAJASEKHAR (MD)
Entity Type:Individual
Prefix:
First Name:RAJASEKHAR
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 JODECO ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:770-692-4000
Mailing Address - Fax:770-474-8510
Practice Address - Street 1:3333 JODECO ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-692-4000
Practice Address - Fax:770-474-8510
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA059177207RC0000X, 207RI0011X, 207RI0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA428105084AMedicaid
I72186Medicare UPIN
GA428105084AMedicaid