Provider Demographics
NPI:1790939122
Name:NAGARATNA REDDY MD
Entity Type:Organization
Organization Name:NAGARATNA REDDY MD
Other - Org Name:REDDY FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-545-3631
Mailing Address - Street 1:217 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70764
Mailing Address - Country:US
Mailing Address - Phone:225-545-3631
Mailing Address - Fax:
Practice Address - Street 1:217 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2527
Practice Address - Country:US
Practice Address - Phone:225-545-3631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05775R207Q00000X
LA15680R207R00000X
LAPA A10313363AM0700X
LAPA200199363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626597Medicaid
LA1949248Medicaid
LA1445118Medicaid
LA1469238Medicaid
LA1949809Medicaid
LA1320251Medicaid
LA1948144Medicaid
LA1948292Medicaid
LA1445118Medicaid
LA1949809Medicaid
LA1320251Medicaid
LA1948144Medicaid