NPIMap

Individual provider Active NPI

Krishna V Gumidyala, MD

  • Orthopaedic Surgery of the Spine Physician
  • Atlanta, GA
National Provider Identifier
1649486994
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
.064382 Issued in GA
Practice address
5667 Peachtree Dunwoody Rd Ste 220
Atlanta, GA 30342-1725
Phone
(404) 252-2422
Fax
(404) 252-6223
NPI assigned
May 15, 2007
Last updated
Feb 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 064382 GA
Orthopaedic Surgery of the Spine Physician 207XS0117X .064382 GA Primary

Addresses

Primary practice location

5667 Peachtree Dunwoody Rd Ste 220
Atlanta, GA 30342-1725

Mailing address

5667 Peachtree Dunwoody Rd Ste 220
Atlanta, GA 30342-1725
Phone (404) 252-2422

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180815002970 GA Practitioner - Orthopedic Surgery 0648324251 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carrollton Orthopaedic Clinic PCGroup PAC ID 7810989183, 31 clinicians

Practice addresses (Care Compare)

150 Clinic Ave
Carrollton, GA 30117-4498
Phone (770) 834-0873

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion86
Laminectomy or laminotomy (partial removal of spine bones)30

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
.064382GAMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Aug 19, 2019 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Aug 19, 2019 Accepting new patients
Carrollton Orthopaedic Clinic PC Orthopaedic Surgery CurrentSince Aug 28, 2023 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Mayo Clinic Health System in Waycross, Inc. Past Accepting new patients

Locations

150 Clinic Ave
Carrollton, GA 30117
Phone (770) 834-0873

150 Clinic Ave
Ste 101
Carrollton, GA 30117
Phone (770) 834-0873

812 S Park St
Ste 3
Carrollton, GA 30117
Phone (770) 241-9255

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

401 Permian Way
Ste D
Villa Rica, GA 30180

705 Dallas Hwy
Ste 301
Villa Rica, GA 30180
Phone (770) 456-0211

Interoperability endpoints

  • Direct secure messaging: kgumidyala71101@directwellstar.org
  • Direct secure messaging: krishna.gumidyala@po.eclinicaldirectplus.com

Organizations & group practices 6

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1649486994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD STE 220",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421725",
            "telephone_number": "404-252-2422",
            "fax_number": "404-252-6223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5667 PEACHTREE DUNWOODY RD STE 220",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421725",
            "telephone_number": "404-252-2422",
            "fax_number": "404-252-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUMIDYALA",
        "first_name": "KRISHNA",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2023-02-06",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "064382",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "GA",
            "license": ".064382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.