Healthcare Provider Details

I. General information

NPI: 1306942578
Provider Name (Legal Business Name): JAGADEESH RUDRAPPA GANJI M.D. FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST STE 300
GREENSBORO NC
27401-1037
US

IV. Provider business mailing address

PO BOX 745040
ATLANTA GA
30374-5040
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax: 336-938-0755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200100363
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number200100363
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: