Provider Demographics
NPI:1700834108
Name:REDDY, CHURKU MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:CHURKU
Middle Name:MOHAN
Last Name:REDDY
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 1:1916 PATTERSON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2120
Mailing Address - Country:US
Mailing Address - Phone:615-329-9888
Mailing Address - Fax:615-329-2345
Practice Address - Street 1:1916 PATTERSON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2120
Practice Address - Country:US
Practice Address - Phone:615-329-9888
Practice Address - Fax:615-329-2345
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN9410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3159017Medicaid
TNBO2751Medicare UPIN