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General NPI Number Information
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NPI Number | 1760808109
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Entity Type | Individual
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Provider Name | RAVEENA REDDY
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Gender | Female
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-1540
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 PEACHTREE DUNWOODY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1764
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Country | US
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Telephone | 678-843-7001
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Fax | 419-866-5453
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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 | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | 783L
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 74333
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 37720
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License Number State | SC
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