Healthcare Provider Details

I. General information

NPI: 1740279942
Provider Name (Legal Business Name): JYOTHISHREE RAO PINNAKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 DANNER CT APT 101 APT # 101
MEMPHIS TN
38103-5992
US

IV. Provider business mailing address

53 DANNER CT APT 101 APT # 101
MEMPHIS TN
38103-5992
US

V. Phone/Fax

Practice location:
  • Phone: 508-450-6607
  • Fax:
Mailing address:
  • Phone: 508-450-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number223154
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number48655
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: