Provider Demographics
NPI:1245452598
Name:REDDY, NITYA M (MBBS)
Entity type:Individual
Prefix:DR
First Name:NITYA
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:NITYA
Other - Middle Name:
Other - Last Name:SANNAPAREDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-0191
Practice Address - Fax:770-535-0916
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061151208M00000X
GA000485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01310558OtherAMERIGROUP
GA52318303OtherBCBS
GA515470OtherWELLCARE
GA531391441AMedicaid
GA3422646OtherCIGNA
GA3422646OtherCIGNA