Healthcare Provider Details

I. General information

NPI: 1962420695
Provider Name (Legal Business Name): LAKSHMI PATURU REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MEDLOCK BRIDGE RD SUITE 102
DULUTH GA
30097-8456
US

IV. Provider business mailing address

10700 MEDLOCK BRIDGE RD SUITE 102
DULUTH GA
30097-8456
US

V. Phone/Fax

Practice location:
  • Phone: 678-615-7878
  • Fax: 770-685-1241
Mailing address:
  • Phone: 678-615-7878
  • Fax: 770-685-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number60595
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number60595
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2004008552
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number60595
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2004008552
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: