Provider Demographics
NPI:1720116494
Name:TALAPANENI, JYOTSNA (MD,)
Entity Type:Individual
Prefix:DR
First Name:JYOTSNA
Middle Name:
Last Name:TALAPANENI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PHILIP BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8746
Mailing Address - Country:US
Mailing Address - Phone:770-822-5560
Mailing Address - Fax:770-822-4989
Practice Address - Street 1:301 PHILIP BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8745
Practice Address - Country:US
Practice Address - Phone:770-822-5560
Practice Address - Fax:770-822-4989
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59212207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0-604-569-4OtherECFMG #
GABT7445403OtherDEA
KS0-604-569-4OtherECFMG #