Provider Demographics
NPI:1508875733
Name:AYYAGARI, VENKATACHALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATACHALAM
Middle Name:
Last Name:AYYAGARI
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 1:2784 BARTLETT BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4530
Mailing Address - Country:US
Mailing Address - Phone:901-382-9998
Mailing Address - Fax:901-382-9998
Practice Address - Street 1:2784 BARTLETT BLVD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4530
Practice Address - Country:US
Practice Address - Phone:901-382-9998
Practice Address - Fax:901-382-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 8772207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3181632Medicaid
TN3181632Medicaid
TN3181632Medicare ID - Type Unspecified