Provider Demographics
NPI:1801631288
Name:MEDEPALLI, ANITA MANI (MEDICAL STUDENT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MANI
Last Name:MEDEPALLI
Suffix:
Gender:F
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 CARUSO CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6608
Mailing Address - Country:US
Mailing Address - Phone:770-331-0323
Mailing Address - Fax:
Practice Address - Street 1:1550 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31207-1500
Practice Address - Country:US
Practice Address - Phone:478-301-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program