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General NPI Number Information
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NPI Number | 1790939783
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Entity Type | Organization
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Legal Business Name | MIDTOWN PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 1418 DRESDEN DR NE STE 120
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City | ATLANTA
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State | GA
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Zip | 30319-3599
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Country | US
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Telephone | 404-754-1994
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Fax | 770-783-8975
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Provider Business Mailing Address
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Address Line | 925B PEACHTREE ST NE UNIT 375
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City | ATLANTA
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State | GA
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Zip | 30309-3918
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Country | US
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Telephone | 404-754-1994
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Fax | 770-783-8975
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Authorized Official
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Title or Position | PRESIDENT
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Name | PULI PRAVIN REDDY
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Credential | M.D.
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Telephone | 404-754-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 046220
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License Number State | GA
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