Basic Information
| Provider Information | |||||||||
| NPI: | 1376925503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADDAGATLA | ||||||||
| FirstName: | SWETHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1023 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SELMA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367016780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3348743463 | ||||||||
| FaxNumber: | 3348743511 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 NELSON BROGDON BLVD STE 250 | ||||||||
| Address2: | |||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305185403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704421911 | ||||||||
| FaxNumber: | 6782881064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2015 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 79924 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | AL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 079924 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.