Provider Demographics
NPI:1609996529
Name:MANNEPALLI, SUPRIYA (MD,)
Entity Type:Individual
Prefix:DR
First Name:SUPRIYA
Middle Name:
Last Name:MANNEPALLI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:MRS
Other - First Name:SUPRIYA
Other - Middle Name:
Other - Last Name:MANNEPALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-4840
Practice Address - Fax:770-219-4841
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061798207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-2379261OtherTAX ID#