Individual
KEERTHI MULAMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
145 N MEDICAL PKWY, WOODSTOCK, GA 30189-7031
(770) 592-3000
(770) 592-3075
Mailing address
145 N MEDICAL PKWY, WOODSTOCK, GA 30189-7031
(770) 592-3000
(770) 592-3075
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
69073
GA
207Q00000X
Family Medicine Physician
R8013
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06601009
ECFMG
IA
Enumeration date
06/04/2007
Last updated
10/15/2019
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