Provider Demographics
NPI:1952375354
Name:REDDY, VISHWANATH MUKKAMALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHWANATH
Middle Name:MUKKAMALLA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3827
Mailing Address - Country:US
Mailing Address - Phone:256-237-7990
Mailing Address - Fax:256-237-8881
Practice Address - Street 1:2417 AL HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5349
Practice Address - Country:US
Practice Address - Phone:256-237-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01924OtherBLUE CROSS BLUE SHIELD AL
AL49536960049OtherAMA ME NUMBER
AL04-01961OtherUNITED
AL1980540OtherFIRST HEALTH
ALH45024Medicare UPIN