Provider Demographics
NPI:1417944760
Name:THATI, YOGANANDAM (MD)
Entity Type:Individual
Prefix:DR
First Name:YOGANANDAM
Middle Name:
Last Name:THATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YOGA
Other - Middle Name:NANDAM
Other - Last Name:THATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3633
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-3633
Mailing Address - Country:US
Mailing Address - Phone:615-790-7992
Mailing Address - Fax:615-771-6537
Practice Address - Street 1:743 ROLLING FORK DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5919
Practice Address - Country:US
Practice Address - Phone:615-790-7992
Practice Address - Fax:615-771-6537
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG11667Medicare UPIN
TN3850580Medicare ID - Type Unspecified