Provider Demographics
NPI:1205032612
Name:VENNALAGANTI, PRASHANTH R (MD)
Entity Type:Individual
Prefix:
First Name:PRASHANTH
Middle Name:R
Last Name:VENNALAGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAGHURAM PRASHANTH
Other - Middle Name:
Other - Last Name:VENNALAGANTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4020 HOPEWELL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1704
Mailing Address - Country:US
Mailing Address - Phone:319-621-0859
Mailing Address - Fax:319-621-0859
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR7997207R00000X
IA39125207R00000X
FLME145021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine