Provider Demographics
NPI:1780618637
Name:REDDY, SUBRAMANYAM P (MD)
Entity type:Individual
Prefix:
First Name:SUBRAMANYAM
Middle Name:P
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:253 UPPER RIVERDALE RD
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-997-3300
Mailing Address - Fax:770-997-0637
Practice Address - Street 1:253 UPPER RIVERDALE RD
Practice Address - Street 2:STE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-997-3300
Practice Address - Fax:770-997-0637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA020593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E01099Medicare UPIN