Healthcare Provider Details

I. General information

NPI: 1013620236
Provider Name (Legal Business Name): GUMIDYALA ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 PEACHTREE DUNWOODY RD STE 220
ATLANTA GA
30342-1725
US

IV. Provider business mailing address

4859 OLD TIMBER RIDGE RD NE
MARIETTA GA
30068-1683
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-2422
  • Fax:
Mailing address:
  • Phone: 678-232-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISHNA GUMIDYALA
Title or Position: OWNER
Credential: MD
Phone: 678-232-3004