Provider Demographics
NPI:1033877964
Name:REDDY, KATTEGUMMULA ANJALI
Entity type:Individual
Prefix:
First Name:KATTEGUMMULA
Middle Name:ANJALI
Last Name:REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:NICOLE
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:103 OLD MORGANTOWN RD APT L109A
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2835
Mailing Address - Country:US
Mailing Address - Phone:404-809-1360
Mailing Address - Fax:
Practice Address - Street 1:1200 ALTMORE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2495
Practice Address - Country:US
Practice Address - Phone:770-389-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional