1396748984 NPI number — KARUNA DYAPA REDDY M.D.

Table of content: KARUNA DYAPA REDDY M.D. (NPI 1396748984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396748984 NPI number — KARUNA DYAPA REDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
KARUNA
Provider Middle Name:
DYAPA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDDY
Provider Other First Name:
KARUNA
Provider Other Middle Name:
DYAPA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396748984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303A SHIRLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31533-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-383-8806
Provider Business Mailing Address Fax Number:
912-383-8147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303A SHIRLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31533-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-383-8806
Provider Business Practice Location Address Fax Number:
912-383-8147
Provider Enumeration Date:
05/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  029519 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10057593 . This is a "AMERIGROUP MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 260049820 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000399814H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".