Provider Demographics
NPI:1528237492
Name:RIKA MEDICAL CLINIC
Entity type:Organization
Organization Name:RIKA MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:MANCHIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:678-289-4920
Mailing Address - Street 1:150 MEDICAL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5053
Mailing Address - Country:US
Mailing Address - Phone:678-289-4920
Mailing Address - Fax:678-289-4942
Practice Address - Street 1:6131 S NORCROSS TUCKER RD
Practice Address - Street 2:SUITE 6
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5536
Practice Address - Country:US
Practice Address - Phone:678-205-1959
Practice Address - Fax:678-205-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27368207Q00000X
GA050585207LP2900X
GA26530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty