Provider Demographics
NPI:1891724449
Name:PALACHARLA, SRINADH R (MD)
Entity Type:Individual
Prefix:
First Name:SRINADH
Middle Name:R
Last Name:PALACHARLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3606 HIGHLANDS PKWY SE
Mailing Address - Street 2:BUILDING #1
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5184
Mailing Address - Country:US
Mailing Address - Phone:678-303-5082
Mailing Address - Fax:678-303-5160
Practice Address - Street 1:3606 HIGHLANDS PKWY SE
Practice Address - Street 2:BUILDING #1
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:678-303-5082
Practice Address - Fax:678-303-5160
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA050239207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000932951AMedicaid
GA000932951AMedicaid
GAGRP7100Medicare PIN