Provider Demographics
NPI:1679839666
Name:GORANTLA, VIJAYA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA KUMAR
Middle Name:
Last Name:GORANTLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3950 NEW COVINGTON PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2593
Mailing Address - Country:US
Mailing Address - Phone:901-382-5256
Mailing Address - Fax:901-382-3731
Practice Address - Street 1:3950 NEW COVINGTON PIKE STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2593
Practice Address - Country:US
Practice Address - Phone:901-382-5256
Practice Address - Fax:901-382-3731
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN59449207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology