Provider Demographics
NPI:1578697652
Name:NEELAGARU, NARASIMHULU (MD)
Entity Type:Individual
Prefix:DR
First Name:NARASIMHULU
Middle Name:
Last Name:NEELAGARU
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:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-0007
Mailing Address - Country:US
Mailing Address - Phone:706-335-2000
Mailing Address - Fax:706-335-9593
Practice Address - Street 1:170 CARDIOLOGY PL
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1083
Practice Address - Country:US
Practice Address - Phone:706-335-2000
Practice Address - Fax:706-335-9593
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031081207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0239087OtherBLUE CROSS BLUE SHIELD
GA340262OtherWELLCARE (MEDICAID)
GA00381587AMedicaid
GA10041326OtherAMERIGROUP (MEDICAID)
GAB85103Medicare UPIN