Provider Demographics
NPI:1093795858
Name:SHANTHAVEERAPPA, HARSHA NONAVINAKERE (MD FCCP)
Entity Type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:NONAVINAKERE
Last Name:SHANTHAVEERAPPA
Suffix:
Gender:M
Credentials:MD FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4099
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-0099
Mailing Address - Country:US
Mailing Address - Phone:423-654-7400
Mailing Address - Fax:423-654-7401
Practice Address - Street 1:5109 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3906
Practice Address - Country:US
Practice Address - Phone:423-654-7400
Practice Address - Fax:423-654-7401
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35215207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507145Medicaid
TN1507145Medicaid
TN38787831Medicare PIN