Provider Demographics
NPI:1760725659
Name:JYOTHISHREE PC
Entity Type:Organization
Organization Name:JYOTHISHREE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JYOTHISHREE
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:PINNAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-450-6607
Mailing Address - Street 1:53 DANNER CT APT 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5992
Mailing Address - Country:US
Mailing Address - Phone:508-450-6607
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 626B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5221
Practice Address - Country:US
Practice Address - Phone:901-767-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty