Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 38751 | TN |
Y | 208000000X | Pediatrician | 38751 | TN |
NPI | 1487654752 |
---|---|
Provider Name | Dr. Jaya Venkataraman |
First Address | Germantown, TN 38138 |
Second Address | Germantown, TN 38138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F99456 | (02) | TN |