Provider Demographics
NPI:1811169931
Name:MUPPIDI, SAMATHA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMATHA
Middle Name:
Last Name:MUPPIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMATHA
Other - Middle Name:
Other - Last Name:MULUKUTLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-335-8472
Mailing Address - Fax:678-312-2651
Practice Address - Street 1:1000 MEDICAL CENTER BLVD.
Practice Address - Street 2:KAISER PERMANENTE AT GWINNETT MEDICAL CENTER
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-447-8507
Practice Address - Fax:678-312-2651
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062920208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist