MEDICARE: SOUTH ATLANTA PULMONARY & CRITICAL CARE ASSOCIATES

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	GA023852	GA
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	GA023852	GA
3	207R00000X	Internal Medicine Physician	GA0233852	GA
4	207RP1001X	Pulmonary Disease Physician	GA023852	GA

General Provider Information

NPI Number	:	1255486387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ATLANTA PULMONARY & CRITICAL CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	483 UPPER RIVERDALE RD SW
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2584
Country	:	US
Telephone Number	:	770-991-3888
Fax Number	:	770-994-0278

Provider Business Practice Location Address
First Line	:	483 UPPER RIVERDALE RD SW
Second Line	:	SUITE A
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2584
Country	:	US
Telephone Number	:	770-991-3888
Fax Number	:	770-994-0278

Authorized Official
Title or Position	:	MD
Name	:	RAO S MIKKILINENI
Credential	:	MD
Telephone Number	:	770-991-3888

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	02/03/2026

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