Basic Information
| Provider Information | |||||||||
| NPI: | 1174683544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAGADALA | ||||||||
| FirstName: | PADMAVATHI | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GAJULA | ||||||||
| OtherFirstName: | PADMAVATHI | ||||||||
| OtherMiddleName: | V | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12000 FINDLEY RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300971407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783401 | ||||||||
| FaxNumber: | 7704952304 | ||||||||
| Practice Location | |||||||||
| Address1: | 12000 FINDLEY RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300971407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783401 | ||||||||
| FaxNumber: | 7704952304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | R3930 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 036 099463 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 081621 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1517326 | 05 | IA | MEDICAID | 0360994632 | 05 | IL | MEDICAID | 98734 | 01 | IL | BCBS | OTHER | 036099463 | 05 | IL | MEDICAID |