Provider Demographics
NPI:1891745105
Name:KALATHOOR, JAYALAKSHMI REEDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYALAKSHMI
Middle Name:REEDY
Last Name:KALATHOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 116171
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6171
Mailing Address - Country:US
Mailing Address - Phone:800-919-1190
Mailing Address - Fax:706-737-2272
Practice Address - Street 1:3000 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4915
Practice Address - Country:US
Practice Address - Phone:770-751-2623
Practice Address - Fax:770-751-2627
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA019708207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00388083OtherRAILROAD MEDICARE
GAF10998Medicare UPIN
GA05BDLBNMedicare PIN