Provider Demographics
NPI:1750548566
Name:TULASI R. VANAPALLI, M. D.
Entity type:Organization
Organization Name:TULASI R. VANAPALLI, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TULASI
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:770-968-7421
Mailing Address - Street 1:1115 MOUNT ZION RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2266
Mailing Address - Country:US
Mailing Address - Phone:770-968-7421
Mailing Address - Fax:770-960-0078
Practice Address - Street 1:1115 MOUNT ZION RD
Practice Address - Street 2:SUITE J
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2266
Practice Address - Country:US
Practice Address - Phone:770-968-7421
Practice Address - Fax:770-960-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52151808004OtherBLUE CROSS BLUE SHIELD
GA11SCFNTMedicare PIN
GAD31081Medicare UPIN