Provider Demographics
NPI:1972733616
Name:GOURINENI, VENKATA C (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:C
Last Name:GOURINENI
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 1:988 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6930
Mailing Address - Country:US
Mailing Address - Phone:865-483-4366
Mailing Address - Fax:
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6930
Practice Address - Country:US
Practice Address - Phone:865-483-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51178207R00000X
TN45468207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022553Medicaid
TN103I102611Medicare PIN