Provider Demographics
NPI:1457580508
Name:RHEUMATOLOGY SPECIALTY CLINIC PLLC
Entity Type:Organization
Organization Name:RHEUMATOLOGY SPECIALTY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GANGULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-756-8633
Mailing Address - Street 1:7660 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5941
Mailing Address - Country:US
Mailing Address - Phone:901-753-8633
Mailing Address - Fax:
Practice Address - Street 1:7660 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5941
Practice Address - Country:US
Practice Address - Phone:901-753-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty