Provider Demographics
NPI:1619980810
Name:SHANKAR, TALLAPRAGADA (MD)
Entity Type:Individual
Prefix:DR
First Name:TALLAPRAGADA
Middle Name:
Last Name:SHANKAR
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 1:1365 ROCK QUARRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5044
Mailing Address - Country:US
Mailing Address - Phone:678-289-5054
Mailing Address - Fax:678-565-0473
Practice Address - Street 1:1365 ROCK QUARRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5044
Practice Address - Country:US
Practice Address - Phone:678-289-5054
Practice Address - Fax:678-565-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029242207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00441009BMedicaid
GA11BDSXCMedicare ID - Type Unspecified
GAD41092Medicare UPIN