| Doctor Name: | PANNALA-JAGAN REDDY |
| NPI Number: | 1023073038 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101028438 |
| Business Practice Address: | 510 S Sycamore St Suite F Petersburg, VA - 238035044 |
| Business Phone Number: | 8048610700 |
| Business Fax Number: | 8048634626 |
| Mailing Address: | 510 S Sycamore St, Suite F PETERSBURG |
| State: | VA |
| Postal Code: | 238035044 |
| Phone Number: | 8048610700 |
| Fax Number: | 8048634626 |
| NPI Enumeration Date: | 04/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | 0101028438 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |