Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Pavan Kumar Mamilla, MD

Individual provider Family Medicine Physician · NPI 1417188103

Dr. Pavan Kumar Mamilla, MD is a Family Practice in Alpharetta, Georgia. Qualified in 2004, 22 years ago. Practices with Metro Medical Associates LLC, a 4-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Alabama and Georgia.

Years since qualifying
22
Licensed in
AL, GA
In the registry since
2009
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

11379 Southbridge Pkwy Ste A
Alpharetta, GA 30022-4402
Phone: (770) 777-0750
Fax: (770) 777-0521
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 79227 (GA)
Family Medicine Physician Taxonomy 207Q00000X · Licence MD.33421 (AL)

Record details

NPI number1417188103
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 29, 2009
Last updated in NPPESNovember 2, 2023
Certification dateNovember 2, 2023
Mailing address11379 Southbridge Pkwy Ste A, Alpharetta, GA 30022-4402

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Metro Medical Associates Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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