Provider Demographics
NPI:1730157488
Name:MANCHIREDDY, GEETHA (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:
Last Name:MANCHIREDDY
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 1:2950 STONE HOGAN CONNECTOR RD SW
Mailing Address - Street 2:BUILDING A SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2837
Mailing Address - Country:US
Mailing Address - Phone:678-289-4901
Mailing Address - Fax:678-289-4942
Practice Address - Street 1:2950 STONE HOGAN CONNECTOR RD SW
Practice Address - Street 2:BUILDING A SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2837
Practice Address - Country:US
Practice Address - Phone:678-289-4901
Practice Address - Fax:678-289-4942
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50585207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BDHXFMedicare ID - Type UnspecifiedGA MEDICARE PROVIDER #
H53079Medicare UPIN