Provider Demographics
NPI:1457418816
Name:REDDY, PRATHIMA LANKALA (MD)
Entity type:Individual
Prefix:DR
First Name:PRATHIMA
Middle Name:LANKALA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1019 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-3532
Practice Address - Country:US
Practice Address - Phone:404-366-9311
Practice Address - Fax:404-366-1250
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000901788AMedicaid
GA11BDSXDMedicare ID - Type Unspecified
GA000901788AMedicaid