Provider Demographics
NPI:1174683544
Name:PAGADALA, PADMAVATHI V (MD)
Entity type:Individual
Prefix:MRS
First Name:PADMAVATHI
Middle Name:V
Last Name:PAGADALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PADMAVATHI
Other - Middle Name:V
Other - Last Name:GAJULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:566 PEACHTREE PKWY STE 121
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9792
Mailing Address - Country:US
Mailing Address - Phone:470-866-3200
Mailing Address - Fax:470-866-3270
Practice Address - Street 1:566 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9792
Practice Address - Country:US
Practice Address - Phone:470-866-3200
Practice Address - Fax:470-866-3270
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081621207V00000X, 207V00000X
IL036 099463207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00312955AMedicaid
IL98734OtherBCBS
IL98734OtherBCBS
IL036099463Medicaid
IA1517326Medicaid
IL0360994632Medicaid