Provider Demographics
NPI:1871502492
Name:REDDY, BHASKAR (MD)
Entity type:Individual
Prefix:DR
First Name:BHASKAR
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 SANDERS RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6058
Mailing Address - Country:US
Mailing Address - Phone:770-887-3255
Mailing Address - Fax:770-887-4177
Practice Address - Street 1:960 SANDERS RD STE 700
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6058
Practice Address - Country:US
Practice Address - Phone:770-887-3255
Practice Address - Fax:770-887-4177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055440207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA774380303BMedicaid
GAG61297Medicare UPIN
GAG61297Medicare UPIN