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General NPI Number Information
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NPI Number | 1417656422
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Entity Type | Organization
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Legal Business Name | REDDY VALADRI PRIMARY CARE
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 6211 THOMASTON RD
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City | MACON
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State | GA
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Zip | 31220-7702
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Country | US
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Telephone | 404-200-1373
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Fax |
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Provider Business Mailing Address
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Address Line | 134 ASTON HALL
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City | MACON
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State | GA
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Zip | 31210-1400
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Country | US
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Telephone | 404-200-1373
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RAVINDER VALADRI
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Credential | MD
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Telephone | 404-200-1373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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