Provider Demographics
NPI:1740247055
Name:CHINTALAPUDI, UDAYA B (MD)
Entity type:Individual
Prefix:
First Name:UDAYA
Middle Name:B
Last Name:CHINTALAPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CREEK FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6239
Mailing Address - Country:US
Mailing Address - Phone:678-910-7228
Mailing Address - Fax:
Practice Address - Street 1:4480 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7313
Practice Address - Country:US
Practice Address - Phone:470-509-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0776182085R0202X
GA0596182085R0202X, 2085R0204X
NE223402085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology