Individual
KOTA R REDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6330 PRIMROSE HILL CT, NORCROSS, GA 30092-4544
(770) 903-0144
(770) 903-0145
Mailing address
PO BOX 769609, ROSWELL, GA 30076-8224
(770) 903-0144
(770) 903-0145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
046479
GA
207RC0000X
Cardiovascular Disease Physician
Primary
046479
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000809168B
—
GA
05
—
000809168C
—
GA
05
—
000809168D
—
GA
01
—
1609816123
GEORGIA CLINIC PC NPI # FOR GROUP
GA
Enumeration date
06/02/2006
Last updated
05/05/2016
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