Healthcare Provider Details

I. General information

NPI: 1356559587
Provider Name (Legal Business Name): TANUJA REDDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 11/05/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE SUITE C50
MEMPHIS TN
38103-3438
US

IV. Provider business mailing address

7881 GROVE CT E
GERMANTOWN TN
38138-3301
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5364
  • Fax:
Mailing address:
  • Phone: 817-305-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberN3266
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberN3266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: