Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 063646 | GA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 063646 | GA |
NPI | 1093751133 |
---|---|
Provider Name | Dr. Phani K. Dantuluri |
First Address | Atlanta, GA 30308-2208 |
Second Address | Atlanta, GA 30308-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 01/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269972941A | (05) | GA |
269972941C | (05) | GA |
269972941D | (05) | GA |
269972941E | (05) | GA |
H62645 | (02) |