Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 0401412308 | VA |
Y | 1223P0300X | Periodontist | 8930 | TN |
NPI | 1114156981 |
---|---|
Provider Name | Dr. Ravichandra Juluri |
First Address | Nashville, TN 37221-2262 |
Second Address | Nashville, TN 37208-3599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 14/07/2009 |