Healthcare Provider Details

I. General information

NPI: 1427287267
Provider Name (Legal Business Name): ANANDA REDDY GURRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 SANDHURST DR
FAYETTEVILLE NC
28304-4433
US

IV. Provider business mailing address

557 SANDHURST DR
FAYETTEVILLE NC
28304-4433
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-8114
  • Fax: 910-484-1564
Mailing address:
  • Phone: 910-484-8114
  • Fax: 910-484-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number201201420
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301094184
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number201201420
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: