Individual
SHYLA REDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
480 N MAIN ST STE 202, ALPHARETTA, GA 30009-8386
(678) 619-1974
(678) 619-1975
Mailing address
PO BOX 1385, P O BOX 1385, ALPHARETTA, GA 30009-1385
(678) 619-1974
(678) 619-1975
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
25425
AL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
71622
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003148835A
—
GA
05
—
009932265
—
AL
01
—
01-12861
UNITED HEALTH CARE
AL
05
—
01778200
—
MS
05
—
1167568
—
LA
01
—
202I085489
MEDICARE PTAN
GA
05
—
268099800
—
FL
01
—
51518001
BLUE CROSS
AL
01
—
51538045
BLUE CROSS
AL
Enumeration date
06/05/2006
Last updated
11/10/2014
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