Healthcare Provider Details

I. General information

NPI: 1649486994
Provider Name (Legal Business Name): KRISHNA V GUMIDYALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/06/2023
Certification Date: 01/30/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 404-252-2422
  • Fax: 404-252-6223
Mailing address:
  • Phone: 404-252-2422
  • Fax: 404-252-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number064382
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number.064382
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: