Individual
VIJAYA LAKSHMI GUDAPATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
777 HEMLOCK ST, MSC 117, MACON, GA 31201-2102
(478) 633-7550
Mailing address
5410 MARYLAND WAY, SUITE 300, BRENTWOOD, TN 37027-5064
(615) 377-5670
(615) 377-1678
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
051941
GA
207R00000X
Internal Medicine Physician
25MA07481900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52212638001
BCBS - GA
GA
05
—
815814465A
—
GA
Enumeration date
07/30/2006
Last updated
10/22/2013
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