Provider Demographics
NPI:1689717068
Name:PAVULURI, VIJAYA LAKSHMI (MD,)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:LAKSHMI
Last Name:PAVULURI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2637
Mailing Address - Country:US
Mailing Address - Phone:931-645-3552
Mailing Address - Fax:615-340-2675
Practice Address - Street 1:782 WEATHERLY DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8941
Practice Address - Country:US
Practice Address - Phone:931-645-3552
Practice Address - Fax:615-340-2675
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD309422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3846737Medicaid
TNMD 30942OtherSTATE LICENCE NUMBER
TN3846737Medicare ID - Type Unspecified
TN3846737Medicaid