Healthcare Provider Details

I. General information

NPI: 1356679161
Provider Name (Legal Business Name): SVATHI REDDY MD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY RD BLDG 17 SUITE 100
MARIETTA GA
30067-5491
US

IV. Provider business mailing address

1640 POWERS FERRY RD BLDG 17 SUITE 100
MARIETTA GA
30067-5491
US

V. Phone/Fax

Practice location:
  • Phone: 770-426-9929
  • Fax: 770-426-8293
Mailing address:
  • Phone: 770-426-9929
  • Fax: 770-426-8293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056352
License Number StateGA

VIII. Authorized Official

Name: DR. SVATHI REDDY
Title or Position: OWNER
Credential: M.D.
Phone: 770-426-9929