Healthcare Provider Details

I. General information

NPI: 1972891463
Provider Name (Legal Business Name): PADMA REKHA KOUKUNTLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ALTMORE AVE STE 175
SANDY SPRINGS GA
30342-2598
US

IV. Provider business mailing address

1300 ALTMORE AVE STE 175
SANDY SPRINGS GA
30342-2598
US

V. Phone/Fax

Practice location:
  • Phone: 404-905-5680
  • Fax: 770-764-0077
Mailing address:
  • Phone: 404-905-5680
  • Fax: 770-764-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number276458
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 128519
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number276458
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77417
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42633
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: