Healthcare Provider Details

I. General information

NPI: 1316063209
Provider Name (Legal Business Name): NAGARATNA REDDY M.D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 HIGHWAY 70 S
PIERRE PART LA
70339-4524
US

IV. Provider business mailing address

217 RAILROAD AVE
DONALDSONVILLE LA
70346-2527
US

V. Phone/Fax

Practice location:
  • Phone: 225-473-3931
  • Fax: 225-473-3289
Mailing address:
  • Phone: 985-252-1000
  • Fax: 985-252-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number193832
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15680R
License Number StateLA

VIII. Authorized Official

Name: DR. NAGARATNA REDDY
Title or Position: PHYSICIAN
Credential: MD
Phone: 985-252-1000