Healthcare Provider Details

I. General information

NPI: 1457273062
Provider Name (Legal Business Name): MEDINOVA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 HUNTER RIDGE LN
NORCROSS GA
30092-3759
US

IV. Provider business mailing address

6050 PEACHTREE PKWY STE 240-242
NORCROSS GA
30092-3336
US

V. Phone/Fax

Practice location:
  • Phone: 470-610-9397
  • Fax:
Mailing address:
  • Phone: 470-610-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARICHARANTEJA MADDURI
Title or Position: PRESIDENT
Credential:
Phone: 470-610-9373