Healthcare Provider Details

I. General information

NPI: 1255486387
Provider Name (Legal Business Name): SOUTH ATLANTA PULMONARY & CRITICAL CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 UPPER RIVERDALE RD SW SUITE A
RIVERDALE GA
30274-2584
US

IV. Provider business mailing address

483 UPPER RIVERDALE RD SW SUITE A
RIVERDALE GA
30274-2584
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-3888
  • Fax: 770-994-0278
Mailing address:
  • Phone: 770-991-3888
  • Fax: 770-994-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberGA0233852
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberGA023852
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberGA023852
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberGA023852
License Number StateGA

VIII. Authorized Official

Name: RAO S MIKKILINENI
Title or Position: MD
Credential: MD
Phone: 770-991-3888