Organization
MIDTOWN PLASTIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PULI PRAVIN REDDY M.D. (PRESIDENT)
(404) 754-1994
Entity
Organization
Contact information
Practice address
1418 DRESDEN DR NE STE 120, ATLANTA, GA 30319-3599
(404) 754-1994
(770) 783-8975
Mailing address
925B PEACHTREE ST NE UNIT 375, ATLANTA, GA 30309-3918
(404) 754-1994
(770) 783-8975
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
046220
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487835260
NPI INDIVIDUAL
GA
Enumeration date
11/04/2008
Last updated
09/03/2014
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