Provider Demographics
NPI:1952590952
Name:SIVARAMA K MEDURI MD
Entity Type:Organization
Organization Name:SIVARAMA K MEDURI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIVARAMA
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:MEDURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-226-1300
Mailing Address - Street 1:1020 CHATTANOOGA AVE STE AB
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8880
Mailing Address - Country:US
Mailing Address - Phone:706-226-1300
Mailing Address - Fax:
Practice Address - Street 1:1020 CHATTANOOGA AVE STE AB
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8880
Practice Address - Country:US
Practice Address - Phone:706-226-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020055207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty