Provider Demographics
NPI:1831157932
Name:NAIDU, SUBRAMANYAM K (MD)
Entity type:Individual
Prefix:DR
First Name:SUBRAMANYAM
Middle Name:K
Last Name:NAIDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUBRA
Other - Middle Name:K
Other - Last Name:NAIDU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:226 WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7272
Mailing Address - Country:US
Mailing Address - Phone:770-389-0200
Mailing Address - Fax:770-474-1570
Practice Address - Street 1:226 WILLIS DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7272
Practice Address - Country:US
Practice Address - Phone:770-389-0200
Practice Address - Fax:770-474-1570
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist