Provider Demographics
NPI:1396191698
Name:TADEPALLI, GEETA SANTOSHI (MD)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:SANTOSHI
Last Name:TADEPALLI
Suffix:
Gender:F
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:PO BOX 70567
Mailing Address - Street 2:ETSU DEPARTMENT OF PSYCHIATRY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1707
Mailing Address - Country:US
Mailing Address - Phone:423-439-2225
Mailing Address - Fax:423-439-2250
Practice Address - Street 1:DOGWOOD AVENUE
Practice Address - Street 2:VA BLDG 52
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-439-2225
Practice Address - Fax:423-439-2250
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI72996202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program