{
"Npi": {
"NPI": "1598949547",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MALLU",
"FirstName": "VENKATA",
"MiddleName": "C",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "101 ROYAL CREST CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KATHLEEN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31047-2144",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-319-5962",
"MailingAddressFaxNumber": "478-745-8932",
"FirstLinePracticeLocationAddress": "707 N HOUSTON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARNER ROBINS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31093-2101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-922-4010",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/27/2007",
"LastUpdateDate": "09/08/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "062252",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "062252",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}