MEDICARE: MRS. TULASI RAMA VANAPALLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	024504	GA

General Provider Information

NPI Number	:	1225093461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TULASI RAMA VANAPALLI MD

Provider Business Mailing Address
First Line	:	1115 MOUNT ZION RD
Second Line	:	SUITE J
City	:	MORROW
State	:	GA
Zip	:	30260-2266
Country	:	US
Telephone Number	:	770-968-7421
Fax Number	:	770-960-0078

Provider Business Practice Location Address
First Line	:	1115 MOUNT ZION RD
Second Line	:	SUITE J
City	:	MORROW
State	:	GA
Zip	:	30260-2266
Country	:	US
Telephone Number	:	770-968-7421
Fax Number	:	770-960-0078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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