Provider Demographics
NPI:1962498600
Name:REDDY, SUJATHA NMN (MD)
Entity Type:Individual
Prefix:MISS
First Name:SUJATHA
Middle Name:NMN
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FY RD NE
Mailing Address - Street 2:STE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-257-0170
Mailing Address - Fax:404-591-3146
Practice Address - Street 1:960 JOHNSON FY RD NE
Practice Address - Street 2:STE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1631
Practice Address - Country:US
Practice Address - Phone:404-257-0170
Practice Address - Fax:404-591-3146
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039911207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10859Medicare UPIN
GA16BBBQRMedicare ID - Type Unspecified