Provider Demographics
NPI:1588689699
Name:REDDY, RAVINDER BAIMEEDI (MD)
Entity type:Individual
Prefix:
First Name:RAVINDER
Middle Name:BAIMEEDI
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAVINDER
Other - Middle Name:REDDY
Other - Last Name:BAIMEEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:770-606-8359
Practice Address - Fax:770-382-5762
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063435207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057540512AMedicaid
GA057540512DMedicaid
GA057540512CMedicaid
GA057540512BMedicaid
GA057540512AMedicaid