Provider Demographics
NPI:1952463747
Name:SIDDAMREDDY, UJWAL (MD)
Entity Type:Individual
Prefix:DR
First Name:UJWAL
Middle Name:
Last Name:SIDDAMREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1620 HICKORY ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2312
Mailing Address - Country:US
Mailing Address - Phone:706-270-5003
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:1506 THORNTON AVENUE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8515
Practice Address - Country:US
Practice Address - Phone:706-270-5047
Practice Address - Fax:706-270-5055
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0531562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry