Provider Demographics
NPI:1093751133
Name:DANTULURI, PHANI K (MD)
Entity Type:Individual
Prefix:DR
First Name:PHANI
Middle Name:K
Last Name:DANTULURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:19TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-215-2000
Mailing Address - Fax:404-215-2001
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:19TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-215-2000
Practice Address - Fax:404-215-2001
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063646207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA269972941AMedicaid
GA269972941CMedicaid
GA269972941DMedicaid
GA269972941EMedicaid
H62645Medicare UPIN
GA269972941DMedicaid