Provider Demographics
NPI:1780006437
Name:REDDY, SIDHARTH V (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIDHARTH
Middle Name:V
Last Name:REDDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-487-1232
Practice Address - Street 1:1975 HIGHWAY 54 W
Practice Address - Street 2:SUITE 205
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:678-561-9000
Practice Address - Fax:770-487-1232
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001243213ES0103X
NC608213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003154632AMedicaid
GA202I480208OtherMEDICARE PTAN
GA003154632CMedicaid
GA003154632DMedicaid