Provider Demographics
NPI:1053408328
Name:REDDY, SUJATHA K (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:K
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EMERY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217
Mailing Address - Country:US
Mailing Address - Phone:478-803-7631
Mailing Address - Fax:478-751-4430
Practice Address - Street 1:175 EMERY HIGHWAY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-803-7631
Practice Address - Fax:478-751-4530
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0203852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20385OtherM.D.
GA20385OtherM.D.
GAD42051Medicare UPIN