Healthcare Provider Details

I. General information

NPI: 1275742686
Provider Name (Legal Business Name): RADHIKA GANTI MURTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CLIFTON SPRINGS RD SUITE B
DECATUR GA
30034-4600
US

IV. Provider business mailing address

36 LENOX POINTE NE
ATLANTA GA
30324-3169
US

V. Phone/Fax

Practice location:
  • Phone: 404-243-9500
  • Fax: 404-244-2224
Mailing address:
  • Phone: 404-237-3636
  • Fax: 404-262-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number051991
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number051991
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: