MEDICARE: DR. DYAPA S REDDY MD

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	208000000X	Pediatrics Physician	028307	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
2	028307	OTHER	GA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1659379741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DYAPA S REDDY MD

Provider Business Mailing Address
First Line	:	303B SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2333
Country	:	US
Telephone Number	:	912-384-2474
Fax Number	:	912-384-4995

Provider Business Practice Location Address
First Line	:	303B SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2333
Country	:	US
Telephone Number	:	912-384-2474
Fax Number	:	912-384-4995

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/15/2015

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