MEDICARE: DR. VINAYA K. PUPPALA M.D.

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	208VP0000X	Pain Medicine Physician	71014	GA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	036126601	IL
3	208VP0014X	Interventional Pain Medicine Physician	71014	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548426810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINAYA K. PUPPALA M.D.

Provider Business Mailing Address
First Line	:	403 PERMIAN WAY STE D
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-3226
Country	:	US
Telephone Number	:	470-827-3648
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 ROSWELL RD STE 350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1995
Country	:	US
Telephone Number	:	470-827-3648
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	12/30/2025

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