Healthcare Provider Details

I. General information

NPI: 1508899246
Provider Name (Legal Business Name): SUNEETHA S NUTHALAPATY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNEETHA S KONALA

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 MANCHESTER HWY
MORRISON TN
37357-7589
US

IV. Provider business mailing address

6290 MANCHESTER HWY
MORRISON TN
37357-7589
US

V. Phone/Fax

Practice location:
  • Phone: 931-815-1616
  • Fax: 931-815-1717
Mailing address:
  • Phone: 931-815-1616
  • Fax: 931-815-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMD40108
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: