Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25425 | AL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 71622 | GA |
NPI | 1295774305 |
---|---|
Provider Name | Shyla Reddy |
First Address | Alpharetta, GA 30009-1385 |
Second Address | Alpharetta, GA 30009-8386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003148835A | (05) | GA |
009932265 | (05) | AL |
01-12861 | UNITED HEALTH CARE (01) | AL |
01778200 | (05) | MS |
1167568 | (05) | LA |
202I085489 | MEDICARE PTAN (01) | GA |
268099800 | (05) | FL |
51518001 | BLUE CROSS (01) | AL |
51538045 | BLUE CROSS (01) | AL |
H95447 | (02) |