Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 062504 | GA |
NPI | 1023283751 |
---|---|
Provider Name | Dr. Madhuri Reddynaga Meka |
First Address | Marietta, GA 30060-8949 |
Second Address | Marietta, GA 30060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2008 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20I103275 | PTAN MEDICARE (01) | GA |
808197072H | (05) | GA |