Healthcare Provider Details

I. General information

NPI: 1548426810
Provider Name (Legal Business Name): VINAYA K. PUPPALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 ROSWELL RD STE 350
ATLANTA GA
30342-1995
US

IV. Provider business mailing address

403 PERMIAN WAY STE D
VILLA RICA GA
30180-3226
US

V. Phone/Fax

Practice location:
  • Phone: 470-827-3648
  • Fax:
Mailing address:
  • Phone: 470-827-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036126601
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number71014
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number71014
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: