Individual provider Active NPI

Rohini K Reddy, M.D.

  • Psychiatry Physician
  • Lawrenceville, GA
National Provider Identifier
1407857345
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
057241 Issued in GA
Practice address
227 Scenic Hwy
Suite a
Lawrenceville, GA 30045-5649
Phone
(770) 513-7666
Fax
(770) 513-1093
NPI assigned
Aug 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 057241 GA Primary

Addresses

Primary practice location

227 Scenic Hwy
Suite a
Lawrenceville, GA 30045-5649

Mailing address

227 Scenic Hwy
Suite a
Lawrenceville, GA 30046-5649
Phone (770) 513-7666

Other identifiers 2

IdentifierTypeStateIssuer
057241OtherGA LICENSE
950431556CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070424000127 GA Practitioner - Psychiatry 9739284597

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
057241GAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Alabama Mental Health-Mental Retardation Board Incorpor Past Accepting new patients
East Alabama Mental Health-Mental Retardation Board Incorpor Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1407857345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 SCENIC HWY",
            "address_2": "SUITE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300465649",
            "telephone_number": "770-513-7666",
            "fax_number": "770-513-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 SCENIC HWY",
            "address_2": "SUITE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300455649",
            "telephone_number": "770-513-7666",
            "fax_number": "770-513-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDDY",
        "first_name": "ROHINI",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "057241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA LICENSE",
            "identifier": "057241",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "950431556C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.