Healthcare Provider Details

I. General information

NPI: 1003996281
Provider Name (Legal Business Name): POSAVANIKE S GANARAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL DR
TYLERTOWN MS
39667-2020
US

IV. Provider business mailing address

250 HOSPITAL DR PO BOX465
TYLERTOWN MS
39667-2020
US

V. Phone/Fax

Practice location:
  • Phone: 601-876-4961
  • Fax: 601-876-9172
Mailing address:
  • Phone: 601-876-4961
  • Fax: 601-876-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number07415
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number07415
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: