Basic Information
| Provider Information | |||||||||
| NPI: | 1730387697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEDULA | ||||||||
| FirstName: | GIRIDHAR | ||||||||
| MiddleName: | VENKATA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1968 PEACHTREE RD NW BLDG 5TH | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046054600 | ||||||||
| FaxNumber: | 4043674447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1968 PEACHTREE RD NW BLDG 775TH | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046054600 | ||||||||
| FaxNumber: | 4043674447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | ME110289 | FL | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 204F00000X | DR.0062058 | CO | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | ME110289 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | 90758 | GA | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
No ID Information.