Provider Demographics
NPI:1265843353
Name:BANAVASI, HARSHA VARDHAN REDDY (MD)
Entity Type:Individual
Prefix:
First Name:HARSHA
Middle Name:VARDHAN REDDY
Last Name:BANAVASI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:762-235-2150
Practice Address - Fax:706-291-8380
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2020-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA84103207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease