Provider Demographics
NPI:1841218013
Name:REDDY, RANI S (MD)
Entity type:Individual
Prefix:DR
First Name:RANI
Middle Name:S
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 1:106 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2459
Mailing Address - Country:US
Mailing Address - Phone:912-871-5000
Mailing Address - Fax:912-681-1444
Practice Address - Street 1:106 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2459
Practice Address - Country:US
Practice Address - Phone:912-871-5000
Practice Address - Fax:912-681-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00468201EMedicaid
GAE91101Medicare UPIN
GA11BDDLCMedicare ID - Type Unspecified