Healthcare Provider Details

I. General information

NPI: 1245367721
Provider Name (Legal Business Name): SRINIVASA RAO CHENNAREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL DR STE 330
MACON GA
31217-3895
US

IV. Provider business mailing address

3333 JODECO ROAD SUITE A
MCDONOUGH GA
30253
US

V. Phone/Fax

Practice location:
  • Phone: 478-200-8152
  • Fax:
Mailing address:
  • Phone: 770-692-4000
  • Fax: 770-474-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number84106
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29602
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number84106
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: