MEDICARE: MR. VENKATA NAGA RATNA KRISHNA M AVVA

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	183500000X	Pharmacist	RPH022961	GA

General Provider Information

NPI Number	:	1518259969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VENKATA NAGA RATNA KRISHNA M AVVA

Provider Business Mailing Address
First Line	:	101 CITY CIR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3118
Country	:	US
Telephone Number	:	770-486-9776
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CITY CIR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3118
Country	:	US
Telephone Number	:	770-486-9776
Fax Number	:

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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