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General NPI Number Information
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NPI Number | 1235363581
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Entity Type | Individual
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Provider Name | SWAROOP M REDDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 5 W ALTMAN ST
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City | STATESBORO
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State | GA
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Zip | 30458-5212
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Country | US
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Telephone | 912-764-6906
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Fax | 912-764-3252
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Provider Business Mailing Address
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Address Line | PO BOX 745
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City | STATESBORO
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State | GA
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Zip | 30459-0745
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Country | US
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Telephone | 912-764-6906
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Fax | 912-764-3252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 029292
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License Number State | GA
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