Provider Demographics
NPI:1730341496
Name:REDDY, ADITHYA A (MD)
Entity type:Individual
Prefix:
First Name:ADITHYA
Middle Name:A
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 1:2550 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8665
Mailing Address - Country:US
Mailing Address - Phone:770-850-8464
Mailing Address - Fax:770-850-9727
Practice Address - Street 1:2550 WINDY HILL RD SE
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8665
Practice Address - Country:US
Practice Address - Phone:770-850-8464
Practice Address - Fax:770-850-9727
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018933208100000X
GA615092081P2900X, 208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101094DMedicaid
GA003101094CMedicaid
GA003101094FMedicaid
GA003101094GMedicaid
GA003101094HMedicaid
586088OtherBCBS
GA003101094EMedicaid
GA003101094BMedicaid
KYK081890Medicare PIN
GA003101094GMedicaid
GA003101094DMedicaid
GA202I252110Medicare PIN