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General NPI Number Information
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NPI Number | 1790034239
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Entity Type | Organization
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Legal Business Name | GEETHA MANCHIREDDY M.D. P.C.
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 150 MEDICAL BLVD STE C
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5053
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Country | US
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Telephone | 678-289-4901
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Fax | 678-289-4942
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Provider Business Mailing Address
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Address Line | 150 MEDICAL BLVD STE C
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5053
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Country | US
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Telephone | 678-289-4901
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Fax | 678-289-4942
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Authorized Official
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Title or Position | CORPORATE FINANCIAL OFFICER
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Name | MR. RAVI REDDY
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Credential | CFO
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Telephone | 678-289-4901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 050585
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License Number State | GA
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