Provider Demographics
NPI:1508184102
Name:SARATH B. GANGAVARAPU
Entity Type:Organization
Organization Name:SARATH B. GANGAVARAPU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SARATH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GANGAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-837-3350
Mailing Address - Street 1:1008 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3638
Mailing Address - Country:US
Mailing Address - Phone:423-837-3350
Mailing Address - Fax:423-837-9525
Practice Address - Street 1:1008 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3638
Practice Address - Country:US
Practice Address - Phone:423-837-3350
Practice Address - Fax:423-837-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD163502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C36330Medicare UPIN