Basic Information
| Provider Information | |||||||||
| NPI: | 1639433188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADALA | ||||||||
| FirstName: | HARISH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 HIGHWAY 58 E | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242733007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766795874 | ||||||||
| FaxNumber: | 2766796912 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 NORTHSIDE CHEROKEE BLVD STE 450 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301158020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707213800 | ||||||||
| FaxNumber: | 7707201890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 0101264035 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | 4301099976 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.