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General NPI Number Information
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NPI Number | 1386821726
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Entity Type | Individual
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Provider Name | JALAJA P SIDDAPPA MD
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3073 PANTHERSVILLE RD PATIENT ACCOUNTS
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City | DECATUR
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State | GA
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Zip | 30034-3828
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Country | US
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Telephone | 404-212-5454
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Fax | 404-243-2159
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Provider Business Mailing Address
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Address Line | PO BOX 370407 PATIENT ACCOUNTS OFFICE
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City | DECATUR
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State | GA
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Zip | 30037-0407
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Country | US
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Telephone | 404-212-5454
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Fax | 404-243-2159
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 017085
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License Number State | GA
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