Provider Demographics
NPI:1851592265
Name:REDDY, SHRAVANTIKA (MD)
Entity Type:Individual
Prefix:
First Name:SHRAVANTIKA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6585
Mailing Address - Country:US
Mailing Address - Phone:470-239-8005
Mailing Address - Fax:949-543-2365
Practice Address - Street 1:1670 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6585
Practice Address - Country:US
Practice Address - Phone:470-239-8005
Practice Address - Fax:949-543-2365
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066310207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program