Provider Demographics
NPI:1235371204
Name:GANTA, KARTHEEK (MD)
Entity Type:Individual
Prefix:DR
First Name:KARTHEEK
Middle Name:
Last Name:GANTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE STE 350
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6964
Mailing Address - Country:US
Mailing Address - Phone:865-481-0333
Mailing Address - Fax:865-374-2111
Practice Address - Street 1:988 OAK RIDGE TPKE STE 350
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6964
Practice Address - Country:US
Practice Address - Phone:865-481-0333
Practice Address - Fax:865-374-2111
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN512782084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ028102Medicaid