NPIMap

Individual provider Active NPI

Raviprakash Reddy Mereddy, DMD

  • Dentist
  • Calhoun, GA
National Provider Identifier
1619054582
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN013184 Issued in GA
Practice address
908 Red Bud Rd NE
Calhoun, GA 30701-1969
Phone
(706) 629-8822
Fax
(706) 629-8893
NPI assigned
Oct 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN013184 GA Primary

Addresses

Primary practice location

908 Red Bud Rd NE
Calhoun, GA 30701-1969

Mailing address

PO Box 906
Calhoun, GA 30703-0906
Phone (706) 629-8822

Other identifiers 1

IdentifierTypeStateIssuer
905675835AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN013184GAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Calhoun Family Dentistry, PC Past Accepting new patients
Calhoun Dentistry, LLC 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": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1619054582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 906",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307030906",
            "telephone_number": "706-629-8822",
            "fax_number": "706-629-8893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 RED BUD RD NE",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307011969",
            "telephone_number": "706-629-8822",
            "fax_number": "706-629-8893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEREDDY",
        "first_name": "RAVIPRAKASH",
        "middle_name": "REDDY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "905675835A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calhoun, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.