=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588673776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADADI G. REDDY, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 PARKS AVE
-----------------------------------------------------
City | SCOTTSBORO
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35768-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-259-4745
-----------------------------------------------------
Fax | 256-259-5598
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 331 PARKS AVE
-----------------------------------------------------
City | SCOTTSBORO
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35768-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-259-4745
-----------------------------------------------------
Fax | 256-259-5598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. MADADI GOVIND REDDY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-259-4745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 8169
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------