Individual
SHALINI GAVVA REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1825 MARTHA BERRY BLVD NW, ROME, GA 30165-1625
(706) 238-8012
(706) 238-8013
Mailing address
221 TECHNOLOGY PKWY NW, ROME, GA 30165-1369
(762) 235-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
045935
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000797112D
—
GA
05
—
000797112E
—
GA
Enumeration date
09/16/2005
Last updated
04/29/2020
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