Provider Demographics
NPI:1912703166
Name:MEDHUB
Entity type:Organization
Organization Name:MEDHUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDRANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLAMOTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-675-6025
Mailing Address - Street 1:3203 S CHEROKEE LN STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4461
Mailing Address - Country:US
Mailing Address - Phone:770-675-6025
Mailing Address - Fax:770-676-7814
Practice Address - Street 1:3203 S CHEROKEE LN STE 220
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4461
Practice Address - Country:US
Practice Address - Phone:770-675-6025
Practice Address - Fax:770-676-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty