Organization
DEKALBCOMMUNITYSERVICEBOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DODDAMETIKUR S SIDDAPPA M.D. (STAFF PSYCHIATRIST)
(404) 243-9500
Entity
Organization
Contact information
Practice address
1662 KANAWHA DR, STONE MOUNTAIN, GA 30087-2116
(404) 243-9500
(404) 244-2224
Mailing address
1662 KANAWHA DR, STONE MOUNTAIN, GA 30087-2116
(404) 243-9500
(404) 244-2224
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
021810
GA
Other
Enumeration date
05/09/2007
Last updated
12/04/2007
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