MEDICARE: ADISESHU V. GUNDLAPALLI MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0001X	Clinical & Laboratory Immunology (Internal Medicine) Physician	84117	GA
2	207RI0200X	Infectious Disease Physician	84117	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00440570	OTHER	UT	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1194815795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADISESHU V. GUNDLAPALLI MD, PHD

Provider Business Mailing Address
First Line	:	5815 PINE BROOK RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5225
Country	:	US
Telephone Number	:	18-473-6628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 CHANTILLY DR NE STE 392
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3267
Country	:	US
Telephone Number	:	404-778-3261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/11/2023

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