Individual
DR. VIKRAM REDDY MANDADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6507 PROFESSIONAL PL, RIVERDALE, GA 30274-4941
(770) 991-2100
(770) 991-1385
Mailing address
6507 PROFESSIONAL PL, RIVERDALE, GA 30274-4941
(770) 991-2100
(770) 991-1385
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
058798
GA
207RC0000X
Cardiovascular Disease Physician
058798
GA
207RI0011X
Interventional Cardiology Physician
Primary
058798
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06CBBWF
MEDICARE ID
GA
05
—
659943665A
—
GA
Enumeration date
10/10/2006
Last updated
09/26/2017
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