Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 10210 | SC |
NPI | 1669442711 |
---|---|
Provider Name | Pringle Prithvi Reddy |
First Address | Atlanta, GA 30384-2145 |
Second Address | Columbia, SC 29203-6834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102105 | (05) | SC |
D17636 | (02) | SC |