Individual
HARISH MADALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
460 NORTHSIDE CHEROKEE BLVD STE 450, CANTON, GA 30115-8020
(770) 721-3800
(770) 720-1890
Mailing address
460 NORTHSIDE CHEROKEE BLVD STE 450, CANTON, GA 30115-8020
(770) 721-3800
(276) 679-6912
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301099976
MI
207RH0003X
Hematology & Oncology Physician
0101264035
VA
207RH0003X
Hematology & Oncology Physician
Primary
91670
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91670
GEORGIA MEDICAL LICENSE
GA
Enumeration date
06/29/2012
Last updated
04/11/2024
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