Provider Demographics
NPI:1366807612
Name:PEDDADA, KRANTI VENKATA
Entity type:Individual
Prefix:
First Name:KRANTI
Middle Name:VENKATA
Last Name:PEDDADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 PLEASANT HILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4807
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:855-228-6169
Practice Address - Street 1:3870 PLEASANT HILL RD STE 1
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4807
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:855-228-6169
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99198207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery