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General NPI Number Information
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NPI Number | 1568667863
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Entity Type | Individual
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Provider Name | KISHORE REDDY RASAMALLU MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 12895 KEYSTONE CT
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City | ALPHARETTA
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State | GA
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Zip | 30009-1526
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Country | US
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Telephone | 210-379-8553
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Fax | 910-900-1239
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Provider Business Mailing Address
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Address Line | 12895 KEYSTONE CT
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City | ALPHARETTA
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State | GA
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Zip | 30009-1526
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Country | US
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Telephone | 210-379-8553
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Fax | 910-900-1239
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD432046
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 077148
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD432046
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M9598
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | M9598
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License Number State | TX
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