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General NPI Number Information
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NPI Number | 1437436094
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Entity Type | Organization
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Legal Business Name | C. B. REDDY MD PC
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 610 S 8TH STREET SUITE F
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City | GRIFFIN
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State | GA
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Zip | 30224
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Country | US
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Telephone | 770-228-9719
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Fax | 770-228-8244
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Provider Business Mailing Address
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Address Line | 610 S 8TH STREET SUITE F
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City | GRIFFIN
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State | GA
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Zip | 30224
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Country | US
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Telephone | 770-228-9719
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Fax | 770-228-8244
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CHELUKALA BAFU REDDY
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Credential | MD
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Telephone | 770-228-9719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 27431
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License Number State | GA
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