Healthcare Provider Details

I. General information

NPI: 1932466430
Provider Name (Legal Business Name): SAMATA KAMIREDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 CHANTILLY DR NE
ATLANTA GA
30324-3267
US

IV. Provider business mailing address

1605 CHANTILLY DR NE
ATLANTA GA
30324-3267
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3261
  • Fax:
Mailing address:
  • Phone: 404-778-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101262347
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.207889
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82993
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number82993
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number82993
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: