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General NPI Number Information
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NPI Number | 1659543130
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Entity Type | Individual
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Provider Name | MADHAVI LATHA SIDDHANTHI M.D
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Gender | Female
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 355 TOWER RD NE STE 103
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City | MARIETTA
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State | GA
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Zip | 30060-9410
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Country | US
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Telephone | 770-420-1690
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Fax |
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Provider Business Mailing Address
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Address Line | 700 CHURCH ST NE
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City | MARIETTA
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State | GA
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Zip | 30060-7220
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Country | US
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Telephone | 770-420-1690
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A101944
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | A69137
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License Number State | GA
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