Healthcare Provider Details

I. General information

NPI: 1740444322
Provider Name (Legal Business Name): VANDANA C REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 JESSE JEWELL PKWY SE STE B
GAINESVILLE GA
30501-3874
US

IV. Provider business mailing address

1498 JESSE JEWELL PKWY SE STE B
GAINESVILLE GA
30501-3874
US

V. Phone/Fax

Practice location:
  • Phone: 770-767-3937
  • Fax: 678-387-2297
Mailing address:
  • Phone: 678-381-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number068607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: