Healthcare Provider Details

I. General information

NPI: 1285257600
Provider Name (Legal Business Name): SRIKANTH POPURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 08/28/2023
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG ROAD, SUITE 1AD200
GREENVILLE NC
27834
US

IV. Provider business mailing address

2100 STANTONSBURG ROAD, SUITE 1AD200
GREENVILLE NC
27834
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-3898
  • Fax: 252-847-6255
Mailing address:
  • Phone: 252-847-3898
  • Fax: 252-847-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02476
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2023-02476
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: