Provider Demographics
NPI:1093409823
Name:NALLABOLU, RASHMIKA REDDY
Entity type:Individual
Prefix:
First Name:RASHMIKA REDDY
Middle Name:
Last Name:NALLABOLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 AVA AVE
Mailing Address - Street 2:APT 3110
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504
Mailing Address - Country:US
Mailing Address - Phone:314-341-9325
Mailing Address - Fax:
Practice Address - Street 1:679 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5768
Practice Address - Country:US
Practice Address - Phone:706-953-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN-1238671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program