Provider Demographics
NPI:1124062534
Name:REDDY, NEETU PANNALA-LAKSHMA (MD)
Entity type:Individual
Prefix:
First Name:NEETU
Middle Name:PANNALA-LAKSHMA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEETU
Other - Middle Name:P
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:220 J L WHITE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4895
Mailing Address - Country:US
Mailing Address - Phone:706-299-2200
Mailing Address - Fax:
Practice Address - Street 1:220 J L WHITE DR STE 150
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4895
Practice Address - Country:US
Practice Address - Phone:706-299-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015276170001Medicaid
NJ0096288Medicaid
NJ0096288Medicaid
NJ097208Medicare PIN