Healthcare Provider Details

I. General information

NPI: 1316268782
Provider Name (Legal Business Name): HARI PRASAD RAVIPATI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 ONE HEALING PL
TALLAHASSEE FL
32308-4600
US

IV. Provider business mailing address

907 18TH ST E STE 150
TIFTON GA
31794-3690
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5360
  • Fax: 850-431-5367
Mailing address:
  • Phone: 229-353-3422
  • Fax: 229-353-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME164649
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number069699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: