Provider Demographics
NPI:1174524581
Name:REDDY, LANKALA RAJENDRA (MD)
Entity type:Individual
Prefix:
First Name:LANKALA
Middle Name:RAJENDRA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:150 MEDICAL BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5053
Mailing Address - Country:US
Mailing Address - Phone:770-389-9944
Mailing Address - Fax:770-389-1973
Practice Address - Street 1:150 MEDICAL BLVD
Practice Address - Street 2:STE B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5053
Practice Address - Country:US
Practice Address - Phone:770-389-9944
Practice Address - Fax:770-389-1973
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA047648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
581487734OtherPROMINA CLAIMS
7483096OtherAETNA
782949OtherBCBS
581487734OtherPROMINA
581487734OtherPRINCIPAL
581487734OtherMETRAHEALTH
8563OtherKAISER
2335725OtherAETNA SELECT US HEALTHC
581487734OtherHMO CIGNA
581487734OtherONE HEALTH PLAN
581487734OtherUNICARE
581487734OtherPREFERRED PLAN
581487734OtherOXFORD HEALTHCARE
782949OtherFEP BLUE CROSS BLUE SHIEL
581487734OtherPHCS
581487734OtherPREFERRED HEALTH NETWORK
1200384OtherUNITED HEALTHCARE
581487734OtherGENERAL