Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 79570 | GA |
N | 207RH0003X | Hematology & Oncology | 44706 | TN |
Y | 207RX0202X | Medical Oncology | 79570 | GA |
NPI | 1194983122 |
---|---|
Provider Name | Dr. Venumadhav Reddy Kotla |
First Address | Gainesville, GA 30503-0658 |
Second Address | Gainesville, GA 30501-3834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1514694 | (05) | TN |
4236662 | BCBS (01) | TN |
7100070430 | (05) | KY |