DR. PAVAN KUMAR MAMILLA (M.D) – Family Medicine Physician, NPI 1417188103

DR. PAVAN KUMAR MAMILLA (M.D) is a healthcare provider. based in Alpharetta, Georgia. specializing in FAMILY PRACTICE. They hold the professional credentials M.D. They hold a License No. MD.33421 (AL). The NPI Number for DR. PAVAN KUMAR MAMILLA (M.D) is 1417188103

Main info

Male
22 Years Of Experience
Accepts Medicare Assignment
Name
DR. PAVAN KUMAR MAMILLA (M.D)
NPI
1417188103
Phone
(770) 777-0750
Address
11379 SOUTHBRIDGE PKWY STE A
Enumeration Date
29 July 2009
Last Update Date
2 November 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7707700750
Graduation Year
2004 (22 years ago)
PAC ID
6103072962
Group Practice PAC ID
2567568603
Professional Enrollment ID
I20180523002377
Address ID
GA300224402AL11379PKWY301
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience65
Completeness75
Years active:16State licenses:2Digital endpointsOther names

3,102 FAMILY PRACTICE in GA

Provider Addresses for DR. PAVAN KUMAR MAMILLA (M.D)

  • 11379 SOUTHBRIDGE PKWY STE A

    ALPHARETTA, GA 300224402

    Phone: (770) 777-0750

    Fax: (770) 777-0521

    Type: Mailing

  • Medical Center Parkway, Selma, Dallas County, Alabama, 36701, United States

    SUITE 200

    SELMA, AL 367016780

    Phone: (334) 875-4184

    Fax: (334) 874-3511

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 71 Open Payments records for all available years, with a total value of $1,396.

Total Amount is formed as General ($1,396) + Research ($0) + Ownership ($0) = $1,396.

Last reported payment date: 2024-12-13 • Largest payer in this snapshot: AstraZeneca Pharmaceuticals LP ($219).

Total Amount

$1,396

General + Research + Ownership

Payments

71

Total payment records

General Amount

$1,396

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-13

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-05-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20141007001725IFamily PracticeALTBD
I20180523002377IFamily PracticeGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes21080$0
99213Established patient office or other outpatient visit, 20-29 minutes10450$0
81002Urinalysis, manual test7459$0
G0442Annual alcohol misuse screening, 5 to 15 minutes5050$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit4646$0
View full utilization report →

Insurance plans in this area (ZIP 30022)

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Provider's Procedures

DR. PAVAN KUMAR MAMILLA (M.D) performs procedures in FAMILY PRACTICE. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEAL20610Aspiration and/or injection of large joint or joint capsule1813
INTERNAL MEDICINEAL85610Blood test, clotting time4314

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2567568603View full group profile
NameSpecialtyState
Family PracticeAL
Family PracticeAL
-GA

Reviews

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Frequently asked questions

Can I verify DR. PAVAN KUMAR MAMILLA (M.D) with an NPI only?
You can start verification with NPI 1417188103 for DR. PAVAN KUMAR MAMILLA (M.D), then check state licensing separately.
Is DR. PAVAN KUMAR MAMILLA (M.D) listed as active for patients and plans?
The listing shows DR. PAVAN KUMAR MAMILLA (M.D) as active in the NPI system.
What is DR. PAVAN KUMAR MAMILLA (M.D)'s primary classification?
Family Medicine Physician is the headline specialty for DR. PAVAN KUMAR MAMILLA (M.D) here. Clinical services aligned with this taxonomy classification.
Does DR. PAVAN KUMAR MAMILLA (M.D) list a practice location?
Patients near Alpharetta, Georgia may find DR. PAVAN KUMAR MAMILLA (M.D) in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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