Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 89427 | GA |
N | 111NI0900X | Internist | 89427 | GA |
NPI | 1003304619 |
---|---|
Provider Name | Bannur Ramanna Nandeesh |
First Address | Athens, GA 30606-2797 |
Second Address | Athens, GA 30606-2797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2018 |
Last Update Date | 25/08/2021 |