Basic Information
| Provider Information | |||||||||
| NPI: | 1184756520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REDDY MEDICAL GROUP, LLC | ||||||||
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| OtherOrganizationName: | REDDY MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1061 DOWDY RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306065700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066217575 | ||||||||
| FaxNumber: | 7066217557 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 GENERAL DANIEL AVE N | ||||||||
| Address2: | |||||||||
| City: | DANIELSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306336906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067952211 | ||||||||
| FaxNumber: | 7062459257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | ARU | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7066217575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.