Provider Demographics
NPI:1972632388
Name:KATRAGADDA, SUNEEL BABU (MD)
Entity type:Individual
Prefix:DR
First Name:SUNEEL
Middle Name:BABU
Last Name:KATRAGADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2150 PEACHFORD RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6520
Mailing Address - Country:US
Mailing Address - Phone:770-458-0450
Mailing Address - Fax:770-458-0470
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:SUITE K
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:770-458-0450
Practice Address - Fax:770-458-0470
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL268182084P0804X
GA0592552084P0804X
MI19397452084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA689757662AMedicaid
GA202G709422Medicare PIN
GA202I269422Medicare PIN