Provider Demographics
NPI:1144328576
Name:REDDY, DUBBAKA DEVENDER (MD)
Entity type:Individual
Prefix:
First Name:DUBBAKA
Middle Name:DEVENDER
Last Name:REDDY
Suffix:
Gender:M
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-0655
Mailing Address - Country:US
Mailing Address - Phone:731-925-2300
Mailing Address - Fax:731-925-3506
Practice Address - Street 1:335 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-4078
Practice Address - Country:US
Practice Address - Phone:731-632-5499
Practice Address - Fax:731-925-2157
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000012083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3 170816Medicaid
B03426Medicare UPIN