MEDICARE: SAMATA KAMIREDDY 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	207K00000X	Allergy & Immunology Physician	0101262347	VA
2	207R00000X	Internal Medicine Physician	MD.207889	LA
3	207R00000X	Internal Medicine Physician	82993	GA
4	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	82993	GA
5	207K00000X	Allergy & Immunology Physician	82993	GA

General Provider Information

NPI Number	:	1932466430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMATA KAMIREDDY MD

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

Provider Business Practice Location Address
First Line	:	1605 CHANTILLY DR NE
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	:	04/20/2012
Last Update Date	:	06/10/2022

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