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NPI 1457565541 · Health Maintenance Organization · Stone Mountain, GA
Provider details
- NPI number
- 1457565541
- Entity type
- Organization
- Primary specialty
- Health Maintenance OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Doddametikur Siddappa, Staff Psychiatrist(404) 243-9500
- License
- 021810 (GA)
Specialties & taxonomies
Managed Care Organizations
Practice location
1662 Kanawha Dr
Stone Mountain, GA 30087-2116
Phone: (404) 243-9500
Fax: (404) 244-2224
Approximate (ZIP-level) locationGet directions
Mailing address
1662 Kanawha Dr
Stone Mountain, GA 30087-2116
Registry dates
- Enumerated
- 2007-05-09
- Last updated
- 2007-12-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.