Provider Demographics
NPI:1295134245
Name:PASUPULETI, RAVI KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:KUMAR
Last Name:PASUPULETI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3740 KENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4488
Mailing Address - Country:US
Mailing Address - Phone:469-442-8584
Mailing Address - Fax:
Practice Address - Street 1:5860 JIMMY CARTER BLVD
Practice Address - Street 2:STE 125
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4658
Practice Address - Country:US
Practice Address - Phone:678-935-0150
Practice Address - Fax:678-926-9668
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA71848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine