Healthcare Provider Details

I. General information

NPI: 1477525103
Provider Name (Legal Business Name): BABU V RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 STONEBRIDGE BLVD
JACKSON TN
38305-2179
US

IV. Provider business mailing address

241 STONEBRIDGE BLVD
JACKSON TN
38305-2179
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-3500
  • Fax: 731-660-3507
Mailing address:
  • Phone: 731-660-3500
  • Fax: 731-660-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD0000021480
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: